Advertisement

Find answers, ask questions, and connect with our community around the world.

  • What is the answer to a long term shortage of radiologists?

    Posted by Unknown Member on March 27, 2023 at 8:28 am

    I don’t normally start posts here on AM, but I think this topic will eventually become relevant. Over the past 20 years, radiology providers have set a standard of expectation for service, which is quite amazing.  Most private practices have provider agreements with service standards, including obligations for subspecialists, hours of coverage, and turnaround times.  The current national standards are 45 min or less for ED CTs, 60 minutes or less for inpatient stats, 12 hours or less for all inpatient, and 24 hours or less for all outpatient studies.  IR is a whole different animal, but it also applies to my point.
     
    Radiology is currently experiencing a massive shortage of radiologists. Here are some undisputed facts. 
    * Best estimate is 2000+ positions posted on the ACR and other job boards. 

    * There are 8,000 + radiologists over retirement age still in clinical practice.

    * As the shortage deepens and the volume per radiologist increases, radiologists who may have practiced longer are retiring due to the workload.

    * Volume increase averages 5% annually.

    * Younger generation of radiologists are generally focused on work/lifestyle balance.

    * Average of 1,200 new radiologists enter clinical practice each year.
    [ul] [/ul] All these factors lined up to cause a bomb cyclone for imaging in the US.  Over the next decade, we will NOT have enough radiologists to meet the demands of the healthcare system.  Certain AI products will help with efficiency, but not enough to make a dent.  As provider groups become more short-staffed, they will reach a tipping point where they can no longer meet the service terms of the provider agreement.  This is happening right now, and many groups are struggling with how to deal with it.  In the past, if a practice breached the service standards in the PSA, there was usually a specific reason the group could not meet the standards.  For whatever reason, the hospital would put out an RFP for another provider and would have options.  That is hardly the case today and will be much worse over the coming years.  If every practice is short, how can they take on new business?  Some will try, and most will fail.  Many groups with larger distributed practices will eventually downsize to keep the core group secure, which will mean some smaller hospitals will have extreme difficulty finding service.
     
    So what is the answer?  The first and most obvious is managing utilization.  This has been a long-standing topic but never seems to gain any traction.  In fact, it is getting worse because those volumes are rapidly rising.  With the boomers aging, there will be no end in sight for the demand for imaging.  Still, utilization must be addressed.  I also believe there may need to be a restructuring of service standards and the unrealistic expectations of hospitals and medical staff.  After all, we are a capitalist society, and supply and demand is a reality.  When the supply is high, competition demands top-tier service and quality. In severe shortages, the cost goes up so hospitals will again start to subsidize their radiology provider.  That will come before service standards are relaxed, but eventually, there will not be enough radiologists, no matter the cost.  We will just be shuffling radiologists to the highest bidder.  
     
    Radiologists are living this nightmare of staffing shortages but trying hard to maintain their service standard expectations.  They are doing this at the risk of burnout and, worse total collapse of the practice.  Because they usually don’t share these issues with the hospital until they are close to collapse, most hospital administrations and medical staff are unaware of how fragile radiology is today.  I believe we need to make a concentrated effort to inform hospitals and medical staff about the state of radiology and what we are all facing.  I think each group, even if you are currently fully staffed or short a few FTEs and struggling to recruit, should gather the data and meet with the administration to educate them on what the industry is facing.  Prepare them and let them know there will be few options if the practice collapses.  Be transparent and share the data to get them to partner with you to help maintain security for the hospital and the practice.
     
    It will be interesting to see what will happen over the next decade.  The smoke is turning to fire and there are no firetrucks nearby.  Some will say this will be good for radiologists and it will be in some ways but it will be terrible in others.  One thing is for certain, change is on the way.
     
     

    Unknown Member replied 1 year, 7 months ago 36 Members · 128 Replies
  • 128 Replies
  • g.giancaspro_108

    Member
    March 27, 2023 at 8:43 am

    Admin:  We discussed it with the board, we really stuck our necks out and went to bat for you, and they agreed to allow a pizza party.
     
     
     

    • ljohnson_509

      Member
      March 27, 2023 at 8:50 am

      I think in the near to mid term future there will be a glut again just like every other time since the early 90s. Not sure why?

      Maybe AI, mid levels, more work/less vacation for rads because of bad reimbursement cuts, new rules, more pathways for foreign rads, etc.

      I think many rads would take no vacation and work 12 hour days to maintain or increase salary.

      • gyspygirlus_1313

        Member
        March 27, 2023 at 8:58 am

        Alternate pathway would be the best option imo, especially given the way the govt can control where alternate pathway physicians can actually work.

        Unsure about no vacation and more work. May make sense for more senior rads with private school tuitions and mortgages, but for the Robinhood generation, theyd rather work smarter not harder and would take a pay cut to do so , hence why DR became popular – work from home (salaries didnt change and the ability to do tele radiology didnt rly change beyond being more prevalent), its also why pm&r and psych are more popular.

      • farzadahmadimedrn710_43

        Member
        March 27, 2023 at 8:59 am

        The answer isn’t gatekeeping when we aren’t the ones physically examining and doing a history on a patient. Money is what we need to get through this problem. Imagine the world where Medicare pays $60/RVU and private insurers pay $80/RVU. Everything would get read.
         
        Idiot boomers and gen’xers on this forum scream about how lazy millennials and Gen z are but they’re out of touch delusional old farts who probably sold their practice out to private equity and wonder why no young people are killing themselves at $30/RVU or less.
         
         

        • Unknown Member

          Deleted User
          March 27, 2023 at 9:07 am

          Quote from bluedeep

          The answer isn’t gatekeeping when we aren’t the ones physically examining and doing a history on a patient. 

           
          Gatekeeping is one of the dumbest ideas I have come across on this site although some on here think it is great.

          • rhiannonsmith84

            Member
            March 27, 2023 at 9:16 am

            One thing that can actually be done is training PA’s to do paras, thoras, fluoro, PICCS, thyroid FNA’s, etc., while limiting their scope of practice to non-interperative work.  That would net at least 1 radiologist FTE in most practices.

          • btomba_77

            Member
            March 27, 2023 at 9:17 am

            So what is the answer?  The first and most obvious is managing utilization. This has been a long-standing topic but never seems to gain any traction.  In fact, it is getting worse because those volumes are rapidly rising.  With the boomers aging, there will be no end in sight for the demand for imaging.  Still, utilization must be addressed.  

             
            Not gonna happen in the absence of a true crisis.  We are 13 years out from a bitter fight over healthcare reform.. and there was no will at that time to do anything to get a grip on utilization.
             
            No elected/government officials want to a) stand up to the entrenched lobbies that suckle at the teet of overutilization or b) take the wrath of American patients being told they can’t have a pony. (We nibbled at that in the early 90s with HMOs and gatekeepers and the backlash was swift and harsh.)
             
             
             

            I also believe there may need to be a restructuring of service standards and the unrealistic expectations of hospitals and medical staff. 

             
            It’s been slow, but compared to the early 2010s I think many administrations have learned some lessons.  The days where a hospital president could get frustrated with his radiology group, offer an RFP, and have a willing practice to come in and replace the old group are long gone.
             
            They know they can’t push too hard any more.
             
             
            I 100% agree with open communication to admin [b]with data[/b] … and you need those administrators on your side to manage the politics of b*tchy referrers who have gotten used to 20 min TATs.

      • Unknown Member

        Deleted User
        March 27, 2023 at 9:00 am

        “As much as sharing information is good, administrators do not care about final product they care about TAT and happy clinicians.”
         
        This is certainly true now as it has been but it will have to change.  And the only way to change is pain.  I’m not saying ask them for a subsidy now. I’m saying just start to prepare them with data.
         
        “I think in the near to mid term future there will be a glut again just like every other time since the early 90s. Not sure why?”
         
        All the data shows no way.  Going on my 34 year in the biz and have seen all the swings.  This is the bomb cyclone!
         
        “Imagine the world where Medicare pays $60/RVU and private insurers pay $80/RVU. Everything would get read.”
         
        So your saying that those pushing burnout at 100 RVUs a shift will miraculously be able to do more for another $20 an RVU?  Sure that will be a motivation but eventually lifestyle and health will prevail.  What about those Millennials who want more lifestyle than money?  

        • farzadahmadimedrn710_43

          Member
          March 27, 2023 at 9:11 am

          Quote from Daniel Corbett

          “Imagine the world where Medicare pays $60/RVU and private insurers pay $80/RVU. Everything would get read.”

          So your saying that those pushing burnout at 100 RVUs a shift will miraculously be able to do more for another $20 an RVU?  Sure that will be a motivation but eventually lifestyle and health will prevail.  What about those Millennials who want more lifestyle than money?  

           
          Yes. Millennial here. I’d do 120 RVUs a day at $60/RVU without a sweat and walk home with 1.6 million working 220 days a year. Throw in some private insurers at $80/RVU and maybe I get close to 2 mil :).
           
          If you’re going to pay me $30/RVU? I’m not reading more than 70 RVU a day for a private equity slave master. And go home with 450k comp a year.

          • g.giancaspro_108

            Member
            March 27, 2023 at 9:15 am

            bluedeep, jobs similar to that are out there and Daniel Corbett may be able to connect you to a couple.  
            The people making $30/RVU are employees working for RP or other corporate employers.  Are there private practices making $30/?

            • satyanar

              Member
              March 27, 2023 at 2:18 pm

              Quote from sandeep panga

               Are there private practices making $30/?

               
              No, but there are PP groups that pay their efficient radiologists at that rate and the slower ones are subsidized by them and make $70 per RVU or more. What happens when “that’s the way we have always done it.”

              • Drthekra

                Member
                March 30, 2023 at 10:33 pm

                Quote from Thread Enhancer

                Quote from sandeep panga

                Are there private practices making $30/?

                No, but there are PP groups that pay their efficient radiologists at that rate and the slower ones are subsidized by them and make $70 per RVU or more. What happens when “that’s the way we have always done it.”

                 
                At least they didn’t sell to RP? 

          • gyspygirlus_1313

            Member
            March 27, 2023 at 9:19 am

            From the way you’re talking you already sound burned out. Are you sure that would be sustainable? And as alluded to , if you are willing to actually take a shower in the morning and drive in to work, I bet you could find something similar to what you are saying you’d work very hard for. 
             

            • lisbef3_453

              Member
              March 27, 2023 at 10:14 am

              Dan’s point is that we are on the cusp of a true crisis.   There is no backbench and the concept of increasing payments per click is so hopelessly optimistic as to be laughable (short of it being issued in hyperinflated fiatbucks).
              Rads don’t have the stomach to be gatekeepers and as a whole only show spine when poaching someone else’s contract.  I would bank on an IP DRG styled payment scheme for the ED imposed from the top down sooner than later.    The historically high percentage of employed physicians in more markets makes a Kaiser type system more likely in those places than before.
               

              • farzadahmadimedrn710_43

                Member
                March 27, 2023 at 10:22 am

                Quote from Adahn

                the concept of increasing payments per click is so hopelessly optimistic as to be laughable (short of it being issued in hyperinflated fiatbucks).

                 
                You’re out of touch. Hospitals have been starting to subsidize groups more and more to get the work done. If the supply of radiologists is drying up they’ll have to pay the remaining radiologists more to incentivize the work to be done. You can’t have a hospital function with the ED having multi-hour turn around times on their STAT studies.

              • btomba_77

                Member
                March 27, 2023 at 10:30 am

                Quote from Adahn

                Dan’s point is that we are on the cusp of a true crisis. 

                 
                I’m sure there are *some* practices that are on the verge of crisis.
                 
                But I think we’re at least a few years or many more away from something that gets the attention of government/regulators in a way that would make someone willing to play hardball on utilization restriction.
                 
                When will that crisis come? I don’t know.  But I doubt any steps are taken to fix it before the $hit hits the fan..
                 
                 

                There is no backbench and the concept of increasing payments per click is so hopelessly optimistic as to be laughable (short of it being issued in hyperinflated fiatbucks).

                 
                 
                Agree. The continued grind on financial payments likely means decreased inflation-adjusted government/payer comp per click over time.
                 
                But … and it’s a big but… Radiology is still a big driver of hospital revenue.  A shortage of radiologists means hospital support to rads… so their paychecks might not suffer… and might actually do well as long as hospital systems are solvent. 
                 

                    The historically high percentage of employed physicians in more markets makes a Kaiser type system more likely in those places than before.

                  Agree. More consolidation and more integration between provider/insurer in various geographies  is a very possible industry response.

                • gyspygirlus_1313

                  Member
                  March 27, 2023 at 10:50 am

                  But … and it’s a big but… Radiology is still a big driver of hospital revenue.  A shortage of radiologists means hospital support to rads… so their paychecks might not suffer… and might actually do well as long as hospital systems are solvent. 

                   
                  In the past in this scenario, their response is usually to turn to cheaper providers at the cost of accuracy, as profits > care to them (which is ironic in its own right bc these mid levels are part of the reason for the increased imaging burden).
                  Obviously this is an overgeneralization of administrators, and everyone’s miles may vary. 

                  • btomba_77

                    Member
                    March 27, 2023 at 10:53 am

                    Absolutely.

                    Mid-level increased interpretation of imaging is, imho, a much more likely response than addressing overutilization.

                    But it’s not a quick fix that’s “shovel ready” … and even once that mid-level approach takes hold it will take a good while to scale up.

                    • Unknown Member

                      Deleted User
                      March 27, 2023 at 11:15 am

                      Another solution- albeit less popular, create more flexible reading positions. Let those that already have one main job, work other side gigs via teleradiology to help fill in the gaps and pay them accordingly. This will appeal mainly to the younger rads here and those that keep touting the want  “FIRE” by aid 40’s lol

                    • btomba_77

                      Member
                      March 27, 2023 at 11:16 am

                      Quote from Sir Read Alot

                      Another solution- albeit less popular, create more flexible reading positions. Let those that already have one main job, work other side gigs via teleradiology to help fill in the gaps and pay them accordingly. This will appeal mainly to the younger rads here and those that keep touting the want  “FIRE” by aid 40’s lol

                      that is already happening.

                    • gmail.com

                      Member
                      March 27, 2023 at 11:27 am

                      So the thinking is raise the reimbursement but does this just facilitate rads to make money faster so they can hit their retirement number and then exit the workforce at say age 55 vs 62?

                      Quote from Sir Read Alot

                      Another solution- albeit less popular, create more flexible reading positions. Let those that already have one main job, work other side gigs via teleradiology to help fill in the gaps and pay them accordingly. This will appeal mainly to the younger rads here and those that keep touting the want  “FIRE” by aid 40’s lol

                    • kbrough_732

                      Member
                      March 27, 2023 at 11:32 am

                      Should find way to “scale” efficient rads to allow those that want to earn more to do so outside of traditional practice models. no production formula can account for the large variability in production I’ve seen in private practice. My former group of 15 in CA had people doing 7k and some doing 20k all getting paid the same because “that’s how the group has always done it.” No reason why someone fast in private practice can’t cover a reader position, as well as a slow boomer, while billing RP/envision an hourly rate for 6-8 rvus an hour.

                    • 22002469

                      Member
                      March 27, 2023 at 7:13 pm

                      Quote from Rearden_Steel

                      Should find way to “scale” efficient rads to allow those that want to earn more to do so outside of traditional practice models. no production formula can account for the large variability in production I’ve seen in private practice. My former group of 15 in CA had people doing 7k and some doing 20k all getting paid the same because “that’s how the group has always done it.” No reason why someone fast in private practice can’t cover a reader position, as well as a slow boomer, while billing RP/envision an hourly rate for 6-8 rvus an hour.

                       
                      This makes sense but who does all the extra work in 15 person group X in CA?
                       
                      If this group of 15 rads on average is reading 14k wRVU/year/FTE, they’re reading 210k wRVU per year. The group is only averaging 14k because they have faster rads picking up the slack. If all the fast rads that are getting underpaid take their excess production elsewhere, suddenly the group is averaging 10k wRVU/year/FTE and is 60k wRVU short. Need to hire a lot more rads for the same volume.
                       
                      I like the side gig idea too, but it’s not quite as simple as letting fast radiologists do their own thing. Internal moonlighting better if you can set up reasonable system. 

                    • satyanar

                      Member
                      March 27, 2023 at 7:35 pm

                      RSF, sounds to me like RS did an indeed take their excess production elsewhere. I wonder how their former group is doing.

                      I agree that a fair internal moonlighting system would be better than going outside of a group to make the fast workers whole.

                • gmail.com

                  Member
                  March 27, 2023 at 11:25 am

                  The ER has a major role in the hospital revenue.  An ER that is humming along like a well-oiled machine is music to a hospital CFOs ears.  And radiology plays a vital role there.  If the ER throughput is negatively affected you will see it on the top line very soon.

                  Quote from dergon

                  Quote from Adahn

                  Dan’s point is that we are on the cusp of a true crisis. 

                  I’m sure there are *some* practices that are on the verge of crisis.

                  But I think we’re at least a few years or many more away from something that gets the attention of government/regulators in a way that would make someone willing to play hardball on utilization restriction.

                  When will that crisis come? I don’t know.  But I doubt any steps are taken to fix it before the $hit hits the fan..

                  There is no backbench and the concept of increasing payments per click is so hopelessly optimistic as to be laughable (short of it being issued in hyperinflated fiatbucks).

                  Agree. The continued grind on financial payments likely means decreased inflation-adjusted government/payer comp per click over time.

                  But … and it’s a big but… Radiology is still a big driver of hospital revenue.  A shortage of radiologists means hospital support to rads… so their paychecks might not suffer… and might actually do well as long as hospital systems are solvent. 

                    The historically high percentage of employed physicians in more markets makes a Kaiser type system more likely in those places than before.

                    Agree. More consolidation and more integration between provider/insurer in various geographies  is a very possible industry response.

          • enrirad2000

            Member
            March 31, 2023 at 10:50 am

            Quote from bluedeep

            Quote from Daniel Corbett

            “Imagine the world where Medicare pays $60/RVU and private insurers pay $80/RVU. Everything would get read.”

            So your saying that those pushing burnout at 100 RVUs a shift will miraculously be able to do more for another $20 an RVU?  Sure that will be a motivation but eventually lifestyle and health will prevail.  What about those Millennials who want more lifestyle than money?  

             
            Yes. Millennial here. I’d do 120 RVUs a day at $60/RVU without a sweat and walk home with 1.6 million working 220 days a year. Throw in some private insurers at $80/RVU and maybe I get close to 2 mil :).

            If you’re going to pay me $30/RVU? I’m not reading more than 70 RVU a day for a private equity slave master. And go home with 450k comp a year.

             
            Well said!!

            • ABlotwijk

              Member
              March 31, 2023 at 12:18 pm

              Here’s something that has me concerned. Right now there are about 14 million people who are eligible for low dose chest CT screening for lung cancer, but we are currently only screening 6% of these people in this manner (in the US). Who is going to read all of these CTs once screening really starts to get pushed? (Personally one of my least favorite studies to read)

              • Robbro524_990

                Member
                March 31, 2023 at 1:24 pm

                I bet groups stop doing it, to be honest.

                Too many exams, not enough time or MDs.

                • nasosmunfc_332

                  Member
                  March 31, 2023 at 2:12 pm

                  Someone will always read them when the get paid, this thread is histrionic

              • buckeyeguy

                Member
                March 31, 2023 at 2:35 pm

                Quote from cmndorbt

                Here’s something that has me concerned. Right now there are about 14 million people who are eligible for low dose chest CT screening for lung cancer, but we are currently only screening 6% of these people in this manner (in the US). Who is going to read all of these CTs once screening really starts to get pushed? (Personally one of my least favorite studies to read)

                 
                Why do we keep doing more and more, and suggesting more and more, if we can’t even do it? That’s the most important question. Sorta like the CTA head and neck on every patient all of a sudden for the last 5-7 years, if possible. Are neuro IR guys doing all those, at all hours? LOL. Total waste, especially on the really old people. Just push the tpa and cross your fingers, because the other stuff isn’t even proven, let alone sustainable in any form.

                • Robbro524_990

                  Member
                  March 31, 2023 at 4:19 pm

                  I disagree with the ‘someone will always read them, if they get paid’ idea. If you can make more money reading other exams (and have a limited time to do so), then why would you not read easier, more profitable exams and just eliminate any lung cancer screening programs at your institutions?

                  • buckeyeguy

                    Member
                    March 31, 2023 at 5:59 pm

                    Quote from DOCDAWG

                    I disagree with the ‘someone will always read them, if they get paid’ idea. If you can make more money reading other exams (and have a limited time to do so), then why would you not read easier, more profitable exams and just eliminate any lung cancer screening programs at your institutions?

                     
                    That’s my point. Also, why wouldn’t patients get less and less if the government crap they vote for pays less and less … lol, it’s like the laminated insurance card the .gov gives you
                     
                    But, but … I’ve got the card. You know, the card!

                    • jtvanaus

                      Member
                      April 3, 2023 at 8:28 pm

                      I wrote a long ass diatribe, but no one wants to read that.
                       
                      Heres the TLDR:
                       
                      In it’s current form, the PA/NP supply is elastic.  Physician supply is inelastic and it takes MUCH longer to develop someone as a physician.
                       
                      Were moving towards a two tiered system. 
                       
                      Doctors for rich people (which may or may not include you) and PAs/NPs for the masses.

                    • william.wang_997

                      Member
                      April 3, 2023 at 9:15 pm

                      Doesn’t matter with MD or PA/NP in deaths among Americans though.
                       
                       If you live in a democratic/liberal state; your chances of living longer are much higher than a republican/ conservative state.
                       
                      “”Americans die younger in conservative states than in those governed by liberals, a new study has found.
                      The authors [link=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0275466]wrote[/link]: Simulations indicate that changing all policy domains in all states to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives.

                      The study was [link=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0275466]published[/link] on Plos One, an inclusive journal community working together to advance science for the benefit of society, now and in the future.
                      The authors are from Syracuse University in New York, Harvard in Massachusetts, Virginia Commonwealth University, the University of Washington, the University of Texas at Austin and the University of Western Ontario, in Canada.””
                       

                    • Robbro524_990

                      Member
                      April 3, 2023 at 9:23 pm

                      Well, that’s good because the birthrate in liberal states is below replacement levels (1.5 or so) while the birthrate in conservative states is 2.5. At some point, you need children to have a stable population after all. This liberal state population bomb might be the demise of state pension systems too, eventually.

                      Look at Illinois. Ouch…

                    • jtvanaus

                      Member
                      April 3, 2023 at 11:32 pm

                      Quote from DOCDAWG

                      Well, that’s good because the birthrate in liberal states is below replacement levels (1.5 or so) while the birthrate in conservative states is 2.5. At some point, you need children to have a stable population after all. This liberal state population bomb might be the demise of state pension systems too, eventually.

                      [i][b]Look at Illinois. Ouch…[/b][/i]

                       
                      Not sure what you’re referring to. Could you provide a bit more detail (just enough so I can google).

                    • btomba_77

                      Member
                      April 4, 2023 at 2:32 am

                      Quote from knightrider

                      Quote from DOCDAWG

                      Well, that’s good because the birthrate in liberal states is below replacement levels (1.5 or so) while the birthrate in conservative states is 2.5. At some point, you need children to have a stable population after all. This liberal state population bomb might be the demise of state pension systems too, eventually.

                      [i][b]Look at Illinois. Ouch…[/b][/i]

                      Not sure what you’re referring to. Could you provide a bit more detail (just enough so I can google).

                      Across the developed world fertility rate inversely correlates with educational attainment and income.
                       
                      Educational attainment at the state level and to some extent income now also directly correlates to Democratic voter preference.
                       
                      So it wouldn’t surprise me that the US states with the lowest birth rates were the most liberal.
                       
                       

                    • buckeyeguy

                      Member
                      April 4, 2023 at 6:58 am

                      Quote from DOCDAWG

                      Well, that’s good because the birthrate in liberal states is below replacement levels (1.5 or so) while the birthrate in conservative states is 2.5. At some point, you need children to have a stable population after all. This liberal state population bomb might be the demise of state pension systems too, eventually.

                      Look at Illinois. Ouch…

                       
                      These people are simpletons. They have no idea about reality, or tradeoffs (that’s what libs/tards make a point of to not even attempt to understand about our world) or “sustainability.” That includes legacy and the fact that as gov’t has grown, the collapse of the “blue city/state” has been obvious and “progressive.”
                       
                      America was made great by all the things NOT promoted by these people. It’s amazing how obvious this is, and they claim to be “science” lovers. LOL

                    • buckeyeguy

                      Member
                      April 4, 2023 at 7:03 am

                      Quote from knightrider

                      I wrote a long ass diatribe, but no one wants to read that.

                      Heres the TLDR:

                      In it’s current form, the PA/NP supply is elastic.  Physician supply is inelastic and it takes MUCH longer to develop someone as a physician.

                      Were moving towards a two tiered system. 

                      Doctors for rich people (which may or may not include you) and PAs/NPs for the masses.

                       
                      Back to the topic, since the lefties are irredeemable. The answer is that they desire death and depopulation as proxies of the larger elite who actually desires this. They get paid off in the meantime with “stuff” to do the bidding of the top players, as prostitutes for material (for a generation).
                       
                      The two tiered system was always the most sensible, as long as they don’t keep taxing only the producers. Like Medicaid, it’s just advertising/marketing too, since it doesn’t even improve outcomes, because the people don’t really care about their health. Which is fine with me. Let them enjoy their Newports, dude, they aren’t you and don’t have aptitudes or the same goals you do, either.
                       
                      How do you see the two tiered system in America, let’s say, knightrider? That is the most interesting question, since I more or less agree with you.

                    • jtvanaus

                      Member
                      April 4, 2023 at 11:43 am

                      Quote from Dream Run

                      Quote from knightrider

                      I wrote a long ass diatribe, but no one wants to read that.

                      Heres the TLDR:

                      In it’s current form, the PA/NP supply is elastic.  Physician supply is inelastic and it takes MUCH longer to develop someone as a physician.

                      Were moving towards a two tiered system. 

                      Doctors for rich people (which may or may not include you) and PAs/NPs for the masses.

                      Back to the topic, since the lefties are irredeemable. The answer is that they desire death and depopulation as proxies of the larger elite who actually desires this. They get paid off in the meantime with “stuff” to do the bidding of the top players, as prostitutes for material (for a generation).

                      The two tiered system was always the most sensible, as long as they don’t keep taxing only the producers. Like Medicaid, it’s just advertising/marketing too, since it doesn’t even improve outcomes, because the people don’t really care about their health. Which is fine with me. Let them enjoy their Newports, dude, they aren’t you and don’t have aptitudes or the same goals you do, either.

                      [b]How do you see the two tiered system in America, let’s say, knightrider? That is the most interesting question, since I more or less agree with you.[/b]

                      I’m not sure I understand the question – not trying to be standoffish but I [i]thought[/i] I answered that in my post. 
                      Noctors for “have-nots” and Doctors for the “priveleged”
                      I’m not sure I have more to say, but what would you like me to expand on?

                    • buckeyeguy

                      Member
                      April 4, 2023 at 7:19 pm

                      Quote from knightrider

                      I’m not sure I understand the question – not trying to be standoffish but I [i]thought[/i] I answered that in my post. 
                      Noctors for “have-nots” and Doctors for the “priveleged”
                      I’m not sure I have more to say, but what would you like me to expand on?

                       
                      Will there be new hospitals that say, “Noctor hospital for those with Medic-X card” here. Do the existing hospitals change? “Private St. Luke Hospital Parking here”. How is that introduced to the public? That kind of thing.

                    • Robbro524_990

                      Member
                      April 4, 2023 at 7:42 pm

                      Fertility rate is actually much more elementary than educational level obtained. It’s really more about space and economics.

                      The US suburbs and rural areas have single family homes and lower costs of living, so thus, children are much less of a financial burden than they are in urban areas. Plus, there is also just more ‘space’ for families to physically live and raise them.

                      Historically, people in rural areas also had more children both due to lack of available birth control (until the 1970s and even 1980s) and the economic value add of having more workers or ‘hands’ on the farm (to help produce more end products/crops).

                      With the urbanization of the world, children became more like expensive furniture to display to your rich friends in wealthy cities. Not ideal for family formation, but great if you love big government (someone has to take care of all of the single, unwed women who thought they’d all be Carrie Bradshaw in Sex and The City in perpetuity, etc).

                      I’m fine with individuals and women making their own decisions, certainly, but just don’t ask me for a bailout when urban society all goes to $hit in these cities (which it inevitably will without very liberal immigration).

                      So, it seems that a lot of this impending urban economic downfall is simply based on demographics, lack of physical space, and mismatched economics.

                      Also, I would argue that as one’s IQ increases, then your education level and salary tend to increase too, for both genders. Since prior to the internet, most of the highest paying jobs were in cities, then those with the highest IQs concentrated there. With the rise of online work, though, this might be slowly changing

                      It should be also noted that, in general, men with high IQs are MORE attractive to women, but the converse is not true. Plus, women with higher IQs tend to be MORE selective in their mate choice and usually won’t marry someone much less accomplished or intelligent than they are.

                      So, if you wonder why there are A LOT of intelligent, high-achieving, unwed women in cities, then wonder no more. It’s based on simple supply and demand. There is an oversupply of them and only one George Clooney or Brad Pitt (or someone similar).

                      And, God forbid that these women stoop so low as to date a ‘normal’ guy or a simple tradesmen. They’d rather just die alone…and a growing majority of them WILL, sadly.

                    • smfst7_929

                      Member
                      April 4, 2023 at 9:26 pm

                      Well said docdawg.

                      Sadly, nobody really does a deep dive into the root cause of many issues facing society.

                      The tendency is to become a victim and blame all your ills on the patriarchy and the evil American culture.

                      Liberals literally indoctrinate people to believe that nothing is their fault.

                      Why is that important? Because where we are heading, we need some resilient people who will do the right thing. Not because they are virtue signaling to gain approval from the twitter mob, but because they are doing what is right on a common sense basis. Crazy to think that doing the right thing is so twisted in our society now

                    • jtvanaus

                      Member
                      April 5, 2023 at 1:56 am

                      Quote from Dream Run

                      Quote from knightrider

                      I’m not sure I understand the question – not trying to be standoffish but I [i]thought[/i] I answered that in my post. 
                      Noctors for “have-nots” and Doctors for the “priveleged”
                      I’m not sure I have more to say, but what would you like me to expand on?

                      Will there be new hospitals that say, “Noctor hospital for those with Medic-X card” here. Do the existing hospitals change? “Private St. Luke Hospital Parking here”. How is that introduced to the public? That kind of thing.

                      [i]When John Battelles teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.[/i]
                      [i]Theyre taking him to a local hospital, Mr. Battelles wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. No, theyre not, Dr. Shlain instructed them. You dont want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.[/i]
                      [i]Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Franciscos top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.[/i]
                      [i]For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.[/i]
                      [i]
                      [/i]
                      [link=https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html]https://www.nytimes.com/2…-end-medical-care.html[/link]
                       
                      (FYI, I’m not a huge fan of the grey lady)
                       
                      ***********1
                       
                      I have family already doing this (practicing concierge medicine) and both the physician AND the patient are MUCH happier.

                    • ruszja

                      Member
                      April 5, 2023 at 3:44 am

                      Much of the growth in imaging is the result of non-indicated studies. Much of that is the result of misguided payment policies forced on everyone by CMS. The moment the people who pay figure out how to disincentize over-imaging, our volumes will start to match our capacity.

                      One of our commercial payers limits the ability to order shoulder MRs to orthopedic surgeons and moves those studies to their cheapest contract provider. We don’t see those at the hospitals as those are expensive as sht.

                    • smfst7_929

                      Member
                      April 5, 2023 at 7:21 am

                      Quote from fw

                      Much of the growth in imaging is the result of non-indicated studies. Much of that is the result of misguided payment policies forced on everyone by CMS. The moment the people who pay figure out how to disincentize over-imaging, our volumes will start to match our capacity.

                      One of our commercial payers limits the ability to order shoulder MRs to orthopedic surgeons and moves those studies to their cheapest contract provider. We don’t see those at the hospitals as those are expensive as sht.

                      They will NEVER limit imaging any further than what they already do in the absence of tort reform. The insurance companies would be opening themselves up to lawsuits for undiagnosed debilitating injuries. And it would be very unpopular for medicare/medicaid to limit it further.

                      I guess I shouldnt say NEVER so how about very unlikely in the absence of tort reform

                    • btomba_77

                      Member
                      April 5, 2023 at 7:27 am

                      Quote from sartoriusBIG

                      Quote from fw

                      Much of the growth in imaging is the result of non-indicated studies. Much of that is the result of misguided payment policies forced on everyone by CMS. The moment the people who pay figure out how to disincentize over-imaging, our volumes will start to match our capacity.

                      One of our commercial payers limits the ability to order shoulder MRs to orthopedic surgeons and moves those studies to their cheapest contract provider. We don’t see those at the hospitals as those are expensive as sht.

                      They will NEVER limit imaging any further than what they already do in the absence of tort reform. The insurance companies would be opening themselves up to lawsuits for undiagnosed debilitating injuries. And it would be very unpopular for medicare/medicaid to limit it further.

                      I guess I shouldnt say NEVER so how about very unlikely in the absence of tort reform

                      Even with tort reform, the demand for imaging wouldn’t drop … at least not for a generation until the culture around defensive medicine dies off.
                       
                       
                      [b]Nobody[/b] wants to be the gatekeeper. [b]Nobody[/b] wants to bear the political rage of “rationing” care.
                       
                      That’s why, as I said on page 1, absent a big healthcare crisis, I don’t see a big fix on the horizon.

                    • smfst7_929

                      Member
                      April 5, 2023 at 7:28 am

                      Also keep in mind the older boomer docs who actually know how to do a proper physical exam are retiring. The new generation of providers look to radiology to make or exclude a diagnosis. Sad but just think of all the times they thought it was PE but it was actually a bowel obstruction. Or insert whatever example you want. Sure there are some good young docs out there but a good percentage cant tell an arse from an elbow without radiology.

                    • ruszja

                      Member
                      April 5, 2023 at 7:30 am

                      Quote from sartoriusBIG

                      They will NEVER limit imaging any further than what they already do in the absence of tort reform. The insurance companies would be opening themselves up to lawsuits for undiagnosed debilitating injuries. And it would be very unpopular for medicare/medicaid to limit it further.

                       
                      The insurance companies exempted themselves from liability for their decisions. Not sure where you practice, but some of our commercials have no problem limiting what they pay for. You want that shoulder MRI the day after you are convinced that you ‘must have torn your rotator cuff’. Sure, we are not telling you you can’t have it, its just that we wont pay for it.

                    • buckeyeguy

                      Member
                      April 5, 2023 at 8:06 am

                      Insurance companies without liability? Sounds familiar …
                       
                      Depop coming to a theater near you, for many reasons. Will that help “medical coverage”?

                    • ruszja

                      Member
                      April 5, 2023 at 8:13 am

                      Quote from Dream Run

                      Insurance companies without liability? Sounds familiar …

                       
                      Hey, we have the best politicians money can buy. Of course they exempted themselves and their ‘peer reviewers’ from liability. Because you know, if you pay cash you can still have all the tests and and that transplant that they denied.

                    • satyanar

                      Member
                      April 5, 2023 at 8:49 am

                      Quote from fw

                      Much of the growth in imaging is the result of non-indicated studies. Much of that is the result of misguided payment policies forced on everyone by CMS. The moment the people who pay figure out how to disincentize over-imaging, our volumes will start to match our capacity.

                       
                      CMS does not need to disincentivize over imaging because they can just arbitrarily cut the cost for each study and voila! Problem solved.
                       
                      They absolutely should but dergon is correct. The politicians that want to provide care to everybody don’t have the guts to tell the recipients that care, including medical imaging, will have to be “rationed” in order to be able to afford it.
                       
                       

                    • smfst7_929

                      Member
                      April 5, 2023 at 12:10 pm

                      Yeah but dropping reimbursement any further will exacerbate the radiology shortage. Problem solved temporarily for CMS I suppose with longterm consequences to be determined. Of course clinicians could care less if our reimbursements drop. It wont affect their ordering practices.

                      Would never happen but hypothetically speaking, If you really want to decrease imaging to only appropriate studies, you should subtract $30 from the ordering clinicians reimbursement for every negative exam. I bet the art of the physical exam would get a new lease on life!

                    • satyanar

                      Member
                      April 5, 2023 at 12:27 pm

                      They tried a version of that with the “decision support” software mandate. Brilliant!

                    • btomba_77

                      Member
                      April 5, 2023 at 12:33 pm

                      Quote from sartoriusBIG

                      Yeah but dropping reimbursement any further will exacerbate the radiology shortage.

                       
                      I suppose at some point the reimbursement cuts might hit a threshold where hospitals simply can’t support the radiologists to make up for the shortfall, salaries start to decrease across the board, resident applications drop, and the overall number of rads available starts to decrease.
                       
                      But that’s a decade in the making or more… and thus far, reimbursement cuts have not decreased radiologist supply, and rads have simply responded by working more.
                       
                      We’ll hit the wall maxed out at some point, but I’m skeptical that the argument that cuts of a few percent on reimbursement will acutely exacerbate the shortage will find receptive ears among policy makers.
                       

                      Would never happen but hypothetically speaking, If you really want to decrease imaging to only appropriate studies, you should subtract $30 from the ordering clinicians reimbursement for every negative exam. I bet the art of the physical exam would get a new lease on life!

                      Like you say …. would never happen.  I don’t see any policy policy on the horizon forcing referrers to be the gate keepers of imaging.  We tried that in the 90s and it just didn’t work.
                       
                       

                    • satyanar

                      Member
                      April 5, 2023 at 12:51 pm

                      Quote from dergon

                      But that’s a decade in the making or more… and thus far, reimbursement cuts have not decreased radiologist supply, and rads have simply responded by working more.

                      We’ll hit the wall maxed out at some point, but I’m skeptical that the argument that cuts of a few percent on reimbursement will acutely exacerbate the shortage will find receptive ears among policy makers.

                       
                      Medicare reimbursement works out to about $50 per wRVU. We have thousands of radiologists willing to work for a lot less and crank the volume to make decent wages. Especially for day time work. I’m skeptical as well.
                       
                       
                       
                       

                    • Unknown Member

                      Deleted User
                      April 5, 2023 at 2:04 pm

                      Quote from dergon

                      But that’s a decade in the making or more… and thus far, reimbursement cuts have not decreased radiologist supply, and rads have simply responded by working more.

                      Evidence to support this claim? every pp group I have worked in the past 20 years has worked as hard as it could. The only thing that has upped rad volume recently that I know of is rvu compensation.
                       
                      When the money is shared average rad productivity acts as a weight on top producers. RVU comp has squeezed more rvus from the few high producers when utilized. Most surviving pp groups likely not using rvu comp.
                       
                      Biggest production increases in order. PACS, then final night reads, and now RVU comp.
                       
                      Physician supply is determined at the spigot-residency spots. All residency spots fill either us grad or international.

                    • jtvanaus

                      Member
                      April 5, 2023 at 3:01 pm

                      Also keep in mind the older boomer docs who actually know how to do a proper physical exam are retiring. The new generation of providers look to radiology to make or exclude a diagnosis. Sad but just think of all the times they thought it was PE but it was actually a bowel obstruction. Or insert whatever example you want. Sure there are some good young docs out there but a good percentage cant tell an arse from an elbow without radiology.

                      The art of physical diagnosis was dead when I entered medical school >20 years ago.
                      Even if there was a cultural shift, that skill was lost, at an institutional level, decades ago.

                      The insurance companies exempted themselves from liability for their decisions. Not sure where you practice, but some of our commercials have no problem limiting what they pay for. You want that shoulder MRI the day after you are convinced that you ‘must have torn your rotator cuff’. Sure, we are not telling you you can’t have it, its just that we wont pay for it.

                      Insurance companies dont care anymore.  ACA flipped that mentality on its head.  They used to have to compete for business from employers by being cheapers.  ACA mandated everybody get insurance AND fixed their profit margins at 20%.  How do you increase profit if your margins are fixed? SPEND BABY SPEND. AND, they now had a captive audience for their legally mandated product.
                       
                       

                      CMS does not need to disincentivize over imaging because they can just arbitrarily cut the cost for each study and voila! Problem solved.

                       
                      This doesnt solve the labor problem presented by Mr Corbett in the OP.  You can mandate the price of bread at $0.50; sure, the store will sell it for $0.50, until they run out.  Then what happens? Black market, or in this case, segregated market with a two tiered system, one for the haves, and one for the have nots.
                       

                      Would never happen but hypothetically speaking, If you really want to decrease imaging to only appropriate studies, you should subtract $30 from the ordering clinicians reimbursement for every negative exam. I bet the art of the physical exam would get a new lease on life!

                       
                      This might reduce the amount of exams, but it wont stop.  APPs aint gonna stop ordering, its all they know.
                       
                       

                    • satyanar

                      Member
                      April 5, 2023 at 3:12 pm

                      Quote from knightrider

                      CMS does not need to disincentivize over imaging because they can just arbitrarily cut the cost for each study and voila! Problem solved.

                      This doesnt solve the labor problem presented by Mr Corbett in the OP.  You can mandate the price of bread at $0.50; sure, the store will sell it for $0.50, until they run out.  Then what happens? Black market, or in this case, segregated market with a two tiered system, one for the haves, and one for the have nots.

                       
                      Sarcasm KR, Sarcasm

                    • Unknown Member

                      Deleted User
                      April 5, 2023 at 4:03 pm

                      Had great exam today for the argument to limit imaging orders.
                      STAT ER US scrotum on a 4 month old.   The ER nurse apologized to the sonographer when  he went to get the patient.  
                      Mom called pediatrician about red testicles with swelling.   Ped tells mom to go to ER.   ER PA orders US scrotum.   
                       
                      for what the nurse immediately identified as diaper rash……

                    • buckeyeguy

                      Member
                      April 5, 2023 at 6:20 pm

                      omg lol

                    • lisbef3_453

                      Member
                      April 5, 2023 at 6:54 am

                      Quote from knightrider

                      [i] despite his guilt over what he admits is very special treatment.[/i]
                      [link=https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html]https://www.nytimes.com/2…-end-medical-care.html[/link]

                      Lies.  No guilt was felt.

  • gyspygirlus_1313

    Member
    March 27, 2023 at 8:48 am

    As much as sharing information is good, administrators do not care about final product they care about TAT and happy clinicians. Sharing this information with them may hasten policy we are all fearful of – PA/NP reads, untested utilization of AI. Ultimately this is going to happen regardless and sharing this information will provide an opportunity for a successful compromise but could also hasten the advent of some of radiologys collective fears (which may not be things necessarily to be fearful of but as all humans we prefer what we know)

    • gmail.com

      Member
      March 27, 2023 at 11:21 am

      About mid-levels doing reads.  I’m sure it will be rocky at first with mistakes being made. Patients getting irreversibly injured and lawsuits.  But do you believe that the mid-levels could eventually take on about 20% of the workload and be competent in 5-10 years?   I don’t know anything about anesthesia, but mid-levels do the less complex anesthesia cases and made a dent in anesthesiologists income.   Anyways just a thought.   

      Quote from RadsMonkey12345

      As much as sharing information is good, administrators do not care about final product they care about TAT and happy clinicians. Sharing this information with them may hasten policy we are all fearful of – PA/NP reads, untested utilization of AI. Ultimately this is going to happen regardless and sharing this information will provide an opportunity for a successful compromise but could also hasten the advent of some of radiologys collective fears (which may not be things necessarily to be fearful of but as all humans we prefer what we know)

      • landk_304

        Member
        March 27, 2023 at 12:41 pm

        Quote from PPRad

        About mid-levels doing reads.  I’m sure it will be rocky at first with mistakes being made. Patients getting irreversibly injured and lawsuits.  But do you believe that the mid-levels could eventually take on about 20% of the workload and be competent in 5-10 years?   I don’t know anything about anesthesia, but mid-levels do the less complex anesthesia cases and made a dent in anesthesiologists income.   Anyways just a thought.   

         
        The mistakes aren’t going to stop after a few years adjustment. Every year there will be new midlevels with little training reading studies that previously required med school and 5 years of training. Most radiology lawsuits come from misses on “easy studies,” so keeping them from reading complex studies isn’t going to solve the problem. Unlike anesthesia (and most of clinical medicine) where there could be multiple stories about what happened with a complication – the radiology report and images are always there for review.
         
        Of course, the admins will happily accept misses and lawsuits and just include those losses in their profit calculations.

        • nasosmunfc_332

          Member
          March 27, 2023 at 2:13 pm

          Increased productivity from home readers. Large consolidated systems with large number of rads on one common pacs, likely multistate. If you open up the list to a large enough number of readers, I guarantee there is a part of the group that will be hungry for the extra money 24/7

          Our groups does over 1 million study is a year and has over 100 radiologists and is getting the work done with no problem. Just imagine on a bigger scale

          • btomba_77

            Member
            March 27, 2023 at 2:20 pm

            Quote from lk

            Increased productivity from home readers. Large consolidated systems with large number of rads on one common pacs, likely multistate. If you open up the list to a large enough number of readers, I guarantee there is a part of the group that will be hungry for the extra money 24/7

            Our groups does over 1 million study is a year and has over 100 radiologists and is getting the work done with no problem. Just imagine on a bigger scale

            sounds about like us …
             
            except more like 2 million studies annual
             
             
            (although the hunger isn’t there 24/7 … it’s there from about 7a to 10p … willingness to read late falls off rather dramatically)

            • nasosmunfc_332

              Member
              March 27, 2023 at 2:26 pm

              Our ot demand is from 5 am to 1 am. Supply is typically lower 1-5 am so need less rads anyways,

              If you imagine a multi state organization in varying time zones, no challenges at all

              Of course this implies the end of the small private practice group but that trend has already started

              • william.wang_997

                Member
                March 27, 2023 at 3:11 pm

                1. The practices should become more lifestyle practices to encourage new rads to join.
                 
                2. Increase Radiology residency slots. Continue Alternate Pathway. The problem with this is that we are sucking talent from other countries.
                 
                3. Use AI….Encourage use of AI and use it to sign reports. This may be the evolution of Radiologist. Use it before other modalities adopt it and make radiologist redundant.
                 
                4. Do not go the mid level way. Once the Uber driver gets two year training, your job is GONE, just like ED physicians.

                • amotter

                  Member
                  March 27, 2023 at 3:56 pm

                  I remember when the theme of the board is the glutton of radiologists and we have to reduce the spots. Now the theme is shortage.

                  • william.wang_997

                    Member
                    March 27, 2023 at 5:48 pm

                    Recently a medical colleague of mine e mailed me and asked me to make an addendum in comparison to the outside study and started with:
                     
                    “” We know that you all are super busy and backed up, but I would really appreciate if you take care of this in the coming week”
                     
                    So….with the colleagues that you interact with in your practices/ tumor boards/ ED meetings etc, keep raising the point that we all are short staffed and backed up. That is really the truth. The message will start spreading, it already is in my practice.

                  • viniciusalexgold_821

                    Member
                    March 27, 2023 at 6:01 pm

                    A lot of people here complain about midlevels, and rightfully so. I’m wondering why then people even think about allowing midlevels to read studies. It would just lead radiology down the same path all these other fields are experiencing, and for what? For the list to be cleaner?
                     
                    New generation complaining about boomers selling out. This would be the boomer equivalent to selling out.
                     
                    Let alone I doubt other specialties would even want them to be reading their studies

                    • landk_304

                      Member
                      March 27, 2023 at 6:21 pm

                      Are there actual radiologists calling for mid levels to read studies? The only people calling for this are non-radiologists, other clinicians who think their “reads” of imaging is just as good as a radiologists or admins who are ok with a few lawsuits if it saves them more in salary.

                    • amotter

                      Member
                      March 27, 2023 at 6:28 pm

                      Quote from UncleMinnie

                      Are there actual radiologists calling for mid levels to read studies? The only people calling for this are non-radiologists, other clinicians who think their “reads” of imaging is just as good as a radiologists or admins who are ok with a few lawsuits if it saves them more in salary.

                      There was the UPenn study that talked about how non-radiologists made better reads on CXRs than their residents, effectively throwing their trainees under the bus.

                    • buckeyeguy

                      Member
                      March 27, 2023 at 6:59 pm

                      You guys are better at the least important exam that has been essentially useless for decades! Hahaha!

                    • khodadadi_babak89

                      Member
                      March 28, 2023 at 7:59 am

                      Quote from UncleMinnie

                      Are there actual radiologists calling for mid levels to read studies? The only people calling for this are non-radiologists, other clinicians who think their “reads” of imaging is just as good as a radiologists or admins who are ok with a few lawsuits if it saves them more in salary.

                      Oh my, we need to update you.
                      as above Penn was, and IS using technologists to read chest x-rays. 
                      Not NPS, not PAs, not RRAs, TECHS – with no real medical training.
                      OF course they say they “Train” them first – they say 2 months. My contact said it was 2 weeks.
                      And then – the techs readings are “over-read” by the faculty. (wink, wink) Can anyone explain to me how adding another person in the chain speeds up turn around? It doesn’t – UNLESS you are letting the tech readings go out unchecked (i.e. “preliminary”)

                      On the American Radiologists FB page there has been a recent discussion of this. A person from penn said (paraphrasing) “WAKE UP” Many top tier programs are doing this” I asked for more information and was given none. 

                      Another Penn faculty swooned over his department leadership protecting them from burnout by limiting their hours and having techs step in to read. 
                      I recommended that they PAY RADIOLOGISTS MORE so they can recruit. OR give the studies to pulmonary. At least trained physicians would be reading these. As it stands, they are billing for radiology work and giving a tech interpretation.  As you may imagine, the fatal flaw with these is that Radiology doesn’t make as much money then (for, you know, phantom radiology reports)

                      After I posted, he removed his. He had no real response. 

                      I know other institutions are doing this (as noted above) – Yale is reported to, but I don’t have the smoking gun.
                      There is a paper in the literature about how good NPs are at doing neuro interventional. This is from Columbia in NY. Neuro-intervention is however, owned by Neurosurgery there.

                       

                    • Unknown Member

                      Deleted User
                      March 28, 2023 at 8:05 am

                      Should over reads be considered fraud by the government? I think so. 

                    • buckeyeguy

                      Member
                      March 28, 2023 at 8:54 am

                      There are traps at every angle. We won’t let people live in other time zones to fill demand of overnights, and if we pay people more, fewer will also (me) want to work as much … especially the late or overnight hours.
                       
                      The scam system is really coming to an end. Dergon is right about the fee for service incentives, and the lack of any real teeth behind “policy” for CYA. You’d have to be indemnified, and even in those gubmint systems that are indemnified (I’ve seen them), people still over-order for similar reasons! It’s crazy.

                    • Unknown Member

                      Deleted User
                      March 28, 2023 at 9:12 am

                      You really dont know much of anything do you

                      Just random anti- everything babble even if it blinks you up the keister

                    • landk_304

                      Member
                      March 28, 2023 at 9:47 am

                      Unless every study “over-read” by the radiologist is a full read, rather than batch signing, Yale, Penn, etc are outright committing fraud. It’s incredibly stupid. You can’t hide a radiologist “reading” 1000 chest xrays per day. A lawyer can have a field day with this.

                    • kbrough_732

                      Member
                      March 28, 2023 at 10:46 am

                      Curious Radsoxfan and thread enhancer…why this: “Internal moonlighting better if you can set up reasonable system.” To me this is anticompetitive and limits people from working where they can get paid the most and propagates “the long term shortage of radiologists.” Also as efficient people getting the work done are often the minority in PP, internal moonlighting often enables lazy PP partners to hang around paying people in the group system below market rates. The majority won’t vote for internal moonlighting that costs them money. Remote reading has opened up competition across all groups and it is glorious.

                    • g.giancaspro_108

                      Member
                      March 28, 2023 at 11:06 am

                      That sounds like a group-specific problem.
                      We implemented internal moonlighting and it was very successful in keeping the list caught up and satisfying some people who wanted to earn more.  Of note is that most of the takes were mid-career, the newer rads with one exception were not interested.
                      I’m unclear on why internal moonlighting would be anticompetitive.  Partners and partner-track can still moonlight elsewhere if they want, but generally it works out better for them to moonlight internally.  Are you suggesting we just open it up to independent contractor remote readers?  That would certainly cost us less and result in more money for the partners, but I don’t think that is best long term either for the practice or the profession.
                       
                       

                      Quote from Rearden_Steel

                      Curious Radsoxfan and thread enhancer…why this: “Internal moonlighting better if you can set up reasonable system.” To me this is anticompetitive and limits people from working where they can get paid the most and propagates “the long term shortage of radiologists.” Also as efficient people getting the work done are often the minority in PP, internal moonlighting often enables lazy PP partners to hang around paying people in the group system below market rates. The majority won’t vote for internal moonlighting that costs them money. Remote reading has opened up competition across all groups and it is glorious.

                    • buckeyeguy

                      Member
                      March 28, 2023 at 12:40 pm

                      Quote from sandeep panga

                      That sounds like a group-specific problem.
                      We implemented internal moonlighting and it was very successful in keeping the list caught up and satisfying some people who wanted to earn more.  Of note is that most of the takes were mid-career, the newer rads with one exception were not interested.
                      I’m unclear on why internal moonlighting would be anticompetitive.  Partners and partner-track can still moonlight elsewhere if they want, but generally it works out better for them to moonlight internally.  Are you suggesting we just open it up to independent contractor remote readers?  That would certainly cost us less and result in more money for the partners, but I don’t think that is best long term either for the practice or the profession.

                      Quote from Rearden_Steel

                      Curious Radsoxfan and thread enhancer…why this: “Internal moonlighting better if you can set up reasonable system.” To me this is anticompetitive and limits people from working where they can get paid the most and propagates “the long term shortage of radiologists.” Also as efficient people getting the work done are often the minority in PP, internal moonlighting often enables lazy PP partners to hang around paying people in the group system below market rates. The majority won’t vote for internal moonlighting that costs them money. Remote reading has opened up competition across all groups and it is glorious.

                       
                      you have a good head on your shoulders sandeep
                       
                      what do you see happening in the next 2-3 years?

                    • lisbef3_453

                      Member
                      March 28, 2023 at 1:00 pm

                      Dan’s original point is that the numbers are so big that things like remote reading and internal moonlighting will only nibble at the edges.

                    • nasosmunfc_332

                      Member
                      March 28, 2023 at 1:57 pm

                      Very chicken little thread. Worst case, radiologists get overwhelmed and there is triage of cases, with er/ip being read first and instead of 1-2 days for op, more like a couple weeks. Try going to a canada or uk and see how long the wait to just get many procedures takes.
                       
                      My sense is that increased productivity from internal moonlighting home readers will handle the volumes. Moreover, quality as always will decrease with ct reads becoming like inpatient general xray reads.
                       
                      When I started a few decades back, my x ray reports were very thorough mentioning many incidental findings such as breast clips on cxr, now they are a total of couple lines.

                    • g.giancaspro_108

                      Member
                      March 28, 2023 at 2:24 pm

                      I don’t know.
                       

                      Quote from Dream Run

                       
                      what do you see happening in the next 2-3 years?
                       

                    • satyanar

                      Member
                      March 28, 2023 at 2:25 pm

                      Quote from sandeep panga

                      That sounds like a group-specific problem.
                      We implemented internal moonlighting and it was very successful in keeping the list caught up and satisfying some people who wanted to earn more.  Of note is that most of the takes were mid-career, the newer rads with one exception were not interested.
                      I’m unclear on why internal moonlighting would be anticompetitive.  Partners and partner-track can still moonlight elsewhere if they want, but generally it works out better for them to moonlight internally.  Are you suggesting we just open it up to independent contractor remote readers?  That would certainly cost us less and result in more money for the partners, but I don’t think that is best long term either for the practice or the profession.

                      Quote from Rearden_Steel

                      Curious Radsoxfan and thread enhancer…why this: “Internal moonlighting better[b] if [/b]you can set up reasonable system.” To me this is anticompetitive and limits people from working where they can get paid the most and propagates “the long term shortage of radiologists.” Also as efficient people getting the work done are often the minority in PP, internal moonlighting often enables lazy PP partners to hang around paying people in the group system below market rates. The majority won’t vote for internal moonlighting that costs them money. Remote reading has opened up competition across all groups and it is glorious.

                       
                      About how I would have replied SP. That’s my big bold “if”. You nicely described the “reasonable system”. The key is to make the internal moonlighting as attractive for the partner as the external.
                       
                      Perhaps this doesn’t do much for “the long-term shortage of radiologists” but it can make for a stable small to medium sized group that can reward everyone in their ecosystem. Then perhaps that group will need fewer radiologists and the surplus can help other places in need.

                    • Unknown Member

                      Deleted User
                      March 28, 2023 at 2:57 pm

                      One thing’s for sure- Private equity has changed pp radiology forever. 
                       
                      RP had the cash and ability to start the wfh/day teleradiology movement.  PP has had to compete by doing wfh too. One thing I have learned about most pps- they don’t change unless acted on by an outside force.
                       
                      RVU comp in some form is now also much more common in pp in large part due to private equity.

                    • 22002469

                      Member
                      March 28, 2023 at 3:56 pm

                      Quote from Rearden_Steel

                      Curious Radsoxfan and thread enhancer…why this: “Internal moonlighting better if you can set up reasonable system.” To me this is anticompetitive and limits people from working where they can get paid the most and propagates “the long term shortage of radiologists.” Also as efficient people getting the work done are often the minority in PP, internal moonlighting often enables lazy PP partners to hang around paying people in the group system below market rates. The majority won’t vote for internal moonlighting that costs them money. Remote reading has opened up competition across all groups and it is glorious.

                       
                      Internal moonlighting may or may not be a better system for you personally. Depends on the specifics. Entirely reasonable to view through that lens, but you should be clear about what is going on and the perspective you are taking. You don’t seem to be factoring how your change in behavior (and other fast readers like you) drastically change the dynamics of the group you are already in.
                       
                      If all the fast readers take their excess 5-10k wRVUs elsewhere, suddenly your group of 15 rads needs 20-25 rads to get the same work done and that’s going to make your current job entirely different. You personally may (likely will) come out ahead in the short term, but it’s not like everyone can just suddenly start reading for outside groups with no ramifications.
                       
                      Now if you are saying you are fast but lazy and could easily add 5-10k wRVU onto your pace while doing exactly what you did all along with your group, that’s of course a different story. 

                    • janamicb_883

                      Member
                      March 28, 2023 at 4:11 pm

                      Isnt this good for us in general? Why would we want it to change? Is the shortage really that severe? Studies are still being read reasonably quickly (except chest services at most places). People in the UK sometimes have to wait a month to get their PET read. Thats pretty extreme but still.

                      Speaking of chest – I wager itll be a nice field pretty quick to once AI takes over the mentally boring and laborious part of it, so we can just focus on the interesting, management changing parts of the study (such as looking at the parenchyma etc).

  • leonardogo

    Member
    March 27, 2023 at 11:39 am

    Why do all the boomers and older rads on this forum keep implying younger rads only care about work/life balance or are lazy. From my experience, it is the opposite.
     
    The older rads in my practice used to make the same money for half the work, when that money was worth 1.5x more(thanks to inflation). Those older docs are also the ones that are the slowest and least productive. 
     
    I find it funny how older rads complain about millennials and GenX when they had it easy, and they can’t even keep up with the insane workload that is standard now. Then they expect the younger rads to want to kill themselves for the constantly decreasing pay. 

    • gmail.com

      Member
      March 27, 2023 at 11:43 am

      “that’s how the group has always done it.”

    • Unknown Member

      Deleted User
      March 27, 2023 at 11:49 am

      Older generations always think younger generations are more progressive and lazier

      Not sure this is specific to radiology

      • Unknown Member

        Deleted User
        March 27, 2023 at 12:05 pm

        Im actually between the boomers and the newbies

        Personally I think both groups are cry-babys

        My generation Judys gets sheet done and goes home to hang with the family

        • btomba_77

          Member
          March 27, 2023 at 12:11 pm

          Quote from Chirorad84

          Im actually between the boomers and the newbies

          Personally I think both groups are cry-babys

          My generation Judys gets sheet done and goes home to hang with the family

             [img]https://cdn.guff.com/site_0/media/32000/31873/items/3420e158e738580ad7cc55ec.jpg[/img]

  • elikot

    Member
    March 27, 2023 at 8:11 pm

    So how best to deal with utilization and appropriateness. It would be a lot easier if there were appropriateness criteria and algorithms that could be introduced to and adopted by the ER groups  That way those providers could fall back on them as policy, and skirt some of their concern about being sued for “missing” something. Anyone have nay resources that could be used? Perhaps that is something the ACR needs to take up. (more  specific than what the already publish )

    • btomba_77

      Member
      March 28, 2023 at 2:44 am

      Quote from bostonrad1

      So how best to deal with utilization and appropriateness. It would be a lot easier if there were appropriateness criteria and algorithms that could be introduced to and adopted by the ER groups  That way those providers could fall back on them as policy, and skirt some of their concern about being sued for “missing” something. Anyone have nay resources that could be used? Perhaps that is something the ACR needs to take up. (more  specific than what the already publish )

       
       
       
       
      You can’t make real changes on utilization without a systemic restructuring of American healthcare. You can dress up “appropriateness” all you want, but if at the end of day it causes a net drop in revenue it’s not going to be aggressively implemented.
       
       
       
       
      As long as we primarily live in a fee-for-service world (or even a capitated/bundled world where docs are primarily compensated on productivity), overutilization will be with us.  All of the incentives in the system remain aligned towards doing more imaging.  
       
       
       
      Hospital systems want their insured patients to get a lot of imaging to help make up shortfalls on Medicare/Medicaid patients.
      Referrers want to do the procedure/surgery that they do to put their kids to college, and advanced imaging is a prerequisite for that. 
      Patients expect advanced imaging and are more likely to rate their experience with a doctor negatively if they don’t get the test they think they need.
       
      Radiologists start might talk some game about overutilization and appropriateness. But when they do it’s generally in a self-serving manner. They primarily talk about limiting ED studies which, not coincidentally, are a pain in their a** because they happen STAT and after hours and require their own complex operations to address.
      …   But watch a radiology group’s outpatient CT/MR volume drop by 20% and you’ll hear them screaming like the world is coming to an end.
       
       
       
      As long as those incentives exist, anyone who tries to put the brakes on and be the gatekeeper is going to be the focus of many, many angry people who seem them as a threat to their livelihood. 
       
       
       
      The change will be painful and political. It requires bold bipartisan action at the federal level with a willingness to take on both an entrenched healthcare lobby representing nearly 1/5th of the American economy as well as leading patients (voters) to understand that the for the good of the whole system they might need to make accepts some limitations on the care they receive ([b]rationing!!![/b])   … 
      …which is I why I don’t think it will happen until we’re in a true crisis.
       
       
       
       

       

      • tomjfinck_742

        Member
        March 28, 2023 at 3:43 am

        Utilization has to be a focus.  We all know a large portion of imaging studies we read probably should not have been performed in the first place.  However, there is little incentive for hospital systems to decrease utilization because of direct economic drivers of imaging reimbursement and ER through-put.
         
        For a while now I have thought that a potential way to decrease utilization on the inpatient side is to make hospitals responsible for a portion of the costs after some threshold is met.   For example, contract the hospital as usual but stipulate that services cover up to a certain generous number of exams/rvu per year.  After that, the cost per exam/rvu goes up.  Don’t like the costs adding up? Then help ensure appropriate imaging happens.  Stop with the daily routine ICU chest x-rays or the CT abdomen/pelvis followed by the renal US.  Stop with the CTA head/neck followed by the MRA head/neck simply because the patient happens to be in the MR to complete a stroke work up.  Stop getting CT PE exams for patients who have obvious pneumonia or edema on the preceding chest x-ray.  Could they also have a PE? Sure.  Anyone can always have a PE.
         
        High volumes lead to ever increasing radiology burnout and moral injury.  Some of that cost needs to be transferred to additional stake holders.
         
        In the short term radiology groups are going to have to do more with the same or less resources.  This probably means increasing economic incentives for efficient radiologists with a good breadth of skills.  Groups that don’t do that will lose their efficient radiologists to groups who are willing to incentivize those individuals and allow them to work remotely.
         
         

      • Unknown Member

        Deleted User
        March 28, 2023 at 6:18 am

        Won’t be solved.  Will struggle staying afloat via more at home weekend and night work for all radiologists.  

        • ljohnson_509

          Member
          March 28, 2023 at 6:21 am

          Vicious cycle will ensue where the misery will lead to more rads retiring and going part time.

          • Unknown Member

            Deleted User
            March 28, 2023 at 6:29 am

            Theres only 1731 job ads for radiologists currently on the ACR, and over 60 for usajobs for VA radiologists.  Largest amount of job postings I’ve ever seen.  

  • Unknown Member

    Deleted User
    March 28, 2023 at 4:16 pm

    I think Dan is trying to make us all aware of both present and future issues facing the profession.
     
    I am opposed to allowing mid-levels / noctors to read and interpret imaging studies.  If another doc takes their stab at it, that is their choice, but just make sure they dictate it so there’s a record.  We all went through training where we all knew the case and would get it right, as long as we were not the one taking the case…
     
    Remember that?  Anyone who’s honest will.
     
    I have heard the proposal of doing only directed reports:  answering only the clinical question at hand, and leaving all the other verbatim out of the report.  You still need to look at the entire exam, of course, and you still need to call about unexpected findings and such.  But to just say “acute appendicitis without abscess” sure would save me a lot of time on a busy night or weekend of call.
     
    And then there’s AI.  Lots of hype and press (here on AM and elsewhere), but I have yet to see it do simple tasks like prioritizing exams or flagging acute ICH.  Perhaps this is just my practice, but I’ve attended the lectures at RSNA, and only have glimpses of it being a “solution.”
     
    Perhaps the supply / demand balance can help us through these times.  I agree that we all need to make admin and referring providers aware of the shortage facing all our practices.
     
    One last admonition:  please, at least try, to let go of all this generational BS which seems to cloud these posts.
     
    We’re all in this together, and we’re all wanting our profession to succeed and survive.

    • tdetlie_105

      Member
      March 28, 2023 at 5:03 pm

      Quote from stephenhumes

       And then there’s AI.  Lots of hype and press (here on AM and elsewhere), but I have yet to see it do simple tasks like prioritizing exams or flagging acute ICH.  Perhaps this is just my practice, but I’ve attended the lectures at RSNA, and only have glimpses of it being a “solution.”

       
      We use AI DOC and it flags studies with acute ICH, PE, PTX on CXR, and free air.  At times this is a few minutes before study is actually on the list ready to read. 

      • Robbro524_990

        Member
        March 28, 2023 at 5:33 pm

        At what cost?

        • Gaynorjarvis

          Member
          March 29, 2023 at 12:56 am

          PENN I have heard also uses ultrasound techs to prelim ultrasounds.

          I do however feel like there are some really smart ultrasound techs that can do this even if it’s opening up a possible mid-level creep. Most of ultrasounds are pretty much straightforward however I wouldn’t allow the same tech who scanned it to read it.

          • pankajkaira1982_700

            Member
            March 29, 2023 at 8:38 am

            One possible solution is to adopt South Koreas way of dealing with medicine. Train many more doctors, subspecialists etc… who know what they are doing and don’t order unnecessary tests. Quality is extremely high and midlevels only increase the imaging burden on society as a whole.
             
            Medical school should start from high school and kids can finish in 6 years ~age 24 instead of ~26. Also provide financial assistance so doctors don’t graduate with too much debt.
             
            Unfortunately, this is a systemic issue that is not isolated to just radiology. No one wants to go into medicine if they can earn a living being an influencer using their Iphone.
             
            I suspect radiology will only get worse with time.
             
             
             
             

            • buckeyeguy

              Member
              March 29, 2023 at 2:57 pm

              Quote from Radguy123123

              One possible solution is to adopt South Koreas way of dealing with medicine. Train many more doctors, subspecialists etc… who know what they are doing and don’t order unnecessary tests. Quality is extremely high and midlevels only increase the imaging burden on society as a whole.

              Medical school should start from high school and kids can finish in 6 years ~age 24 instead of ~26. Also provide financial assistance so doctors don’t graduate with too much debt.

              Unfortunately, this is a systemic issue that is not isolated to just radiology. No one wants to go into medicine if they can earn a living being an influencer using their Iphone.

              I suspect radiology will only get worse with time.

               
              Doesn’t it have to be, if ordering that much, pay more, get shorter reports, stop the suits so people can be probability assessed, etc or all/some of the above?
               
              I agree, it seems it’ll only get worse.

        • gmail.com

          Member
          March 29, 2023 at 4:13 pm

          This is my main question.  So if your private practice reads like, for example, 10K CXRs per year, mix of ER, IP, OP – do you run each one thru the PTX algorithm?  And what is the cost to use this algorithm?  Is it per year or per click.
           
          And then the PTX cases gets flagged, you read it and life goes on.
          Will this improve outcomes?  And if it have zero effect, what have you accomplished?  Sure you have advanced as a group using the advanced technology but unless it improves care delivery and patient outcomes,it seems like a waste of money.
           
          I don’t know.

          Quote from DOCDAWG

          At what cost?

          • Robbro524_990

            Member
            March 29, 2023 at 4:33 pm

            Exactly.

            And is it just for PTX? What about large bullae? What about lung nodules and masses?

            If it’s not somewhat comprehensive, then it might be easier (and cheaper?) to just read the $10 exam yourself.

          • melikabukvic

            Member
            April 4, 2023 at 2:16 pm

            I think as the backlog of cases gets worse, the benefit of AI to point out critical cases get higher. That way the outpatient with a PTX or PE doesnt sit on your list for days.

            • btomba_77

              Member
              April 4, 2023 at 3:49 pm

              Quote from raddan

              I think as the backlog of cases gets worse, the benefit of AI to point out critical cases get higher. That way the outpatient with a PTX or PE doesnt sit on your list for days.

              For sure.
               
              There will be a few years (at least) in the “AI as worklist manager” phase.
               
               
               
              Edit – Note: I went to my first meeting with a large imaging company about their cutting edge AI software to move critical findings up the work list in 2016.
               
               
               

        • tdetlie_105

          Member
          March 29, 2023 at 5:04 pm

          Quote from DOCDAWG

          At what cost?

           
          Unsure but not cheap.  Hospital paying for it.

          • gmail.com

            Member
            March 29, 2023 at 5:21 pm

            The cynical side of me says this is good for the hospital.  Catch more incidental stuff that needs to be followed, worked up, biopsied, imaged, etc.  This means more utilization and thus more money to the top line revenue.   Do y’all agree?

            Quote from jd4540

            Quote from DOCDAWG

            At what cost?

            Unsure but not cheap.  Hospital paying for it.

            • Robbro524_990

              Member
              March 29, 2023 at 5:44 pm

              Probably but I think you have more insight on this than they do (ie. They bought the ‘hype’ while the true benefits to them are probably a secondary phenomenon that only radiologists and software engineers will understand or uncover).

              Remember most of these ‘suits’ have very limited medical training or knowledge, especially regarding radiology, AI, and software.

              Don’t give them too much credit.

              • sraghuvanshi1

                Member
                March 30, 2023 at 4:44 am

                Internal moonlighting sounds great in theory and may work well if there are individual worklists or a structured assignment system in place. Absent that, high producers may start to hold some mental energy in reserve for those shifts that are paid extra. Also, since some will naturally do more of these shifts, there will be a compensation gap, which although justified, may create envy and petty resentment.

                • buckeyeguy

                  Member
                  March 30, 2023 at 11:24 am

                  Dr. Humes, the generational stuff isn’t going away. Do you think I won’t get ire from the recent grads soon? And I didn’t make a mint like most of the people in the practices when I trained many years ago, who owned it all and who didn’t retire, etc. The system is going down whether you like it or not, a lot of us are just being honest. To be honest, the american public in large part deserves it – sad but true – they stand for nothing and covid showed that. I always take care of the patient in front of me, so I’m not giving up personally, I’m just assessing the system that is clearly gone-zo. Just to clarify.

            • tdetlie_105

              Member
              March 30, 2023 at 4:14 pm

              Quote from PPRad

              The cynical side of me says this is good for the hospital.  Catch more incidental stuff that needs to be followed, worked up, biopsied, imaged, etc.  This means more utilization and thus more money to the top line revenue.   Do y’all agree?

              Quote from jd4540

              Quote from DOCDAWG

              At what cost?

              Unsure but not cheap.  Hospital paying for it.

               
              While I agree that the Hospital must has some financial incentive (which is unclear to me at this time aside from belief rads will be more efficient), I am not following your reasoning.  This system picks up acute, critical findings…Do you mean that given it takes care of the acute stuff, we have more time for incidentals?

              • afazio.uk_887

                Member
                March 30, 2023 at 4:23 pm

                I have actually looking to pick up some more volume from home and I havent found anything appealing yet. So I dont think demand is that high yet.

                • btomba_77

                  Member
                  March 30, 2023 at 5:33 pm

                  Quote from Waduh Dong

                  I have actually looking to pick up some more volume from home and I havent found anything appealing yet. So I dont think demand is that high yet.

                  As noted upthread, *internal* moonlighting has a lot of demand.
                   
                  It’s also easy for a group to implement. No new PACS stations, no credentialling, no additional malpractice coverage.
                   
                  It’s also *less* expensive for the group to offer.  (They can pay their own radiologists a lot more than those rads would get per click working tele yet still save money because there’s no middle man)
                   
                   
                   
                  So, by the time a group is looking for *outside* help in moonlighting they *and* they don’t have an existing telerad provider to whom they can offload volume, they’re in real dire straits.
                   
                   

                  • nasosmunfc_332

                    Member
                    March 30, 2023 at 5:42 pm

                    Agree, plus the additional income with working more internally is a recruiting tool. It can be sold as salary+

                    In the chance volumes falls, ot typically proportionately falls so win win for group

                    • william.wang_997

                      Member
                      March 30, 2023 at 11:18 pm

                      The most mature and confident group will let moonlight externally while encouraging internally. The problem with strict internal moonlighting is that when the times are tough, you may not be offered extra shifts.
                       

                      Quote from lk

                      Agree, plus the additional income with working more internally is a recruiting tool. It can be sold as salary+

                      In the chance volumes falls, ot typically proportionately falls so win win for group

              • gmail.com

                Member
                March 30, 2023 at 4:25 pm

                For example, pulmonary nodule detection.  How many nodules under 10mm are missed per 100 CTs?  I don’t know but I think it is >=1.   If have AI software that detects this, then you could theoretically get that patient into a lung nodule clinic pathway. Not all patients will be able to be compliant and come for f/u CTs and appts but every patient that does will pay dividends for the “investment” in this AI algorithm.  it is my theory and perhaps not the primary reason for a hospital to get it, but certainly an ancillary benefit.
                 

                Quote from jd4540

                Quote from PPRad

                The cynical side of me says this is good for the hospital.  Catch more incidental stuff that needs to be followed, worked up, biopsied, imaged, etc.  This means more utilization and thus more money to the top line revenue.   Do y’all agree?

                Quote from jd4540

                Quote from DOCDAWG

                At what cost?

                Unsure but not cheap.  Hospital paying for it.

                While I agree that the Hospital must has some financial incentive (which is unclear to me at this time aside from belief rads will be more efficient), I am not following your reasoning.  This system picks up acute, critical findings…Do you mean that given it takes care of the acute stuff, we have more time for incidentals?

                • tdetlie_105

                  Member
                  March 30, 2023 at 5:26 pm

                  Quote from PPRad

                  For example, pulmonary nodule detection.  How many nodules under 10mm are missed per 100 CTs?  I don’t know but I think it is >=1.   If have AI software that detects this, then you could theoretically get that patient into a lung nodule clinic pathway. Not all patients will be able to be compliant and come for f/u CTs and appts but every patient that does will pay dividends for the “investment” in this AI algorithm.  it is my theory and perhaps not the primary reason for a hospital to get it, but certainly an ancillary benefit.

                  Quote from jd4540

                  Quote from PPRad

                  The cynical side of me says this is good for the hospital.  Catch more incidental stuff that needs to be followed, worked up, biopsied, imaged, etc.  This means more utilization and thus more money to the top line revenue.   Do y’all agree?

                  Quote from jd4540

                  Quote from DOCDAWG

                  At what cost?

                  Unsure but not cheap.  Hospital paying for it.

                  While I agree that the Hospital must has some financial incentive (which is unclear to me at this time aside from belief rads will be more efficient), I am not following your reasoning.  This system picks up acute, critical findings…Do you mean that given it takes care of the acute stuff, we have more time for incidentals?

                   
                  Got it…my jaded perspective is that maybe the AI manufacturers will give the hospitals/HC systems a discount when the real stuff comes out, if they bite this early 

  • Unknown Member

    Deleted User
    April 6, 2023 at 7:20 am

    What is the answer to a long term shortage of radiologists? 
     
    ESTRAGON: I can’t go on like this. VLADIMIR: That’s what you think. Beckett Waiting for Godot
     
    or 
     
    “You must go on. I can’t go on. You must go on. I’ll go on. You must say words, as long as there are any” -Beckett, The Unnamable
     
    or
     
    The list is so big! Doesn’t matter- Turn on, tune in, and drop out. 
     

    • Unknown Member

      Deleted User
      April 6, 2023 at 10:12 am

      Coping with the long term shortage of radiologists? 
       
      Film upon film, one by one, and one day, suddenly, there’s a heap, a little heap, the impossible heap. I can’t be punished any more.  Beckett, you dog you, Endgame.

      • Unknown Member

        Deleted User
        April 6, 2023 at 10:19 am

        O list, o infinite list-
         
        or the gift that keeps on giving?

        • Unknown Member

          Deleted User
          April 6, 2023 at 10:23 am

          Second shift list exploding-
          “Raindrops keep falling on my head
          But that doesn’t mean my eyes will soon be turning red
          Crying’s not for me
          ‘Cause I’m never gonna stop the rain by complaining
          Because I’m free
          Nothing’s worrying me”

          • Unknown Member

            Deleted User
            April 6, 2023 at 10:35 am

            Tales from the ER- They keep falling, they keep falling….