My Buddy In Radiology Said The Job Market Is A Disaster: True?

[APDoc]

Of course you can. We can take 100 asymptomatic adults and I am sure we can find a potential pain generator in 90 (perhaps all 100 depending on their carrier). If you provide a targeted history we can look for OBJECTIVE and surgically treatable causes of pain i.e. see whether there is objective significant compression of NEURAL elements which may account for the symptoms. The other "pain generators" are NOT universally accepted, NOT well validated, and do not deserve more detail than the type of general overview of degenerative change that you feel is inadequate. In fact, you should be glad that these reports leave the door open for you to treat this "degenerative change" with the lucrative and not well-validated methods that comprise your specialty! We are not going to read your mind and state that the facet OA at L4/5 is marginally more than that at L3/4, but slightly worse than L5/S1 on the left, uh so I guess the patient needs facet injections at L1-L5...(bilaterally, q2weeks).......

What I can tell you is that you may understand degenerative / mechanical spine disease, but you do not have formal training in imaging, and even less so about imaging of non mechanical disease of the spine, disease of the spinal cord (neoplasms, vascular malformations, infections, inflammatory disease, etc etc) i.e. all the cases that NEVER come to you because of the radiologist's interpretation and referral. I put less than zero stock in your belief that you "read" degenerative cases better than radiologist x, because we all know that that there is very little agreement in this area between anyone! Only the cases that you never see (cord comp, tumors, vasc malfs etc) have a "right answer" interpretation -- that you would never need to make!

But we digress... the job market is much tighter, but there are still jobs out there. Must be flexible.

1. I never suggested I could read films BETTER than any radiologist, I merely insinuated that some radiologists can (or choose to) read them better than other radiologists. Because of these inconsistencies, I read ALL of my own films, as any good clinician should.

2. Maybe you have me confused with some money-grubbing *****/needle jockey with no ethical backbone, but I only treat something with an intervention if I feel very strongly I can treat it well. A true pain physician uses a multi-disciplinary approach, and a needle/minimally-invasive procedure is just one of those disciplines. We have quite a few radiologists in our community who call themselves "pain docs" and stick needles in people M-F and never see them in F/U for an office visit. You might want to talk with the guys who studied in your own specialty first before you start tossing accusations around about the field of pain medicine in general.

3. I sure as hell hope most radiologists are not as defensive as some of the folks on here. Otherwise my buddies finishing up their radiology residencies now are going to be working with some real characters. Take a breath and exhale every now and then...

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[partusa]

If you think that the job market for radiologists is a disaster, just check the NM's!! There is a thread in the NM section.

 

[eddieberetta]

1. I never suggested I could read films BETTER than any radiologist, I merely insinuated that some radiologists can (or choose to) read them better than other radiologists. Because of these inconsistencies, I read ALL of my own films, as any good clinician should.

2. Maybe you have me confused with some money-grubbing *****/needle jockey with no ethical backbone, but I only treat something with an intervention if I feel very strongly I can treat it well. A true pain physician uses a multi-disciplinary approach, and a needle/minimally-invasive procedure is just one of those disciplines. We have quite a few radiologists in our community who call themselves "pain docs" and stick needles in people M-F and never see them in F/U for an office visit. You might want to talk with the guys who studied in your own specialty first before you start tossing accusations around about the field of pain medicine in general.

3. I sure as hell hope most radiologists are not as defensive as some of the folks on here. Otherwise my buddies finishing up their radiology residencies now are going to be working with some real characters. Take a breath and exhale every now and then...

I may have overreacted, for which I apologize. OTOH if you come to a radiologists forum as a pain fellow and complain about degenerative spine cases being "under read" you are going to piss people off (or at least me for sure). We are also going to cynically assume that you are overcalling a lot.

 

[APDoc]

I may have overreacted, for which I apologize. OTOH if you come to a radiologists forum as a pain fellow and complain about degenerative spine cases being "under read" you are going to piss people off (or at least me for sure). We are also going to cynically assume that you are overcalling a lot.

No problem. Again, I'm no radiologist, but I feel I owe it to my patients to review all the studies that I order for them. As I said before, I only go after something I see on imaging if I think I can treat it and it correlates with history/physical findings. I definitely don't apply a novel-like algorithm to my patients to make a quick $-- I couldn't sleep at night.

As I'm sure you have seen, not all radiologists are created equal, and not all clinicians are created equal. Sounds like you and I are at least attempting to do things the right way in our current medical climate.

 

[200UL]

Thank you for doing this, but please understand that you are the exception and not the rule. I read reports from other radiologists all the time, and a lot of the time I walk away thinking "huh?", so I can definitely appreciate what it's like to read a worthless imaging report.

On the other hand, I'd bet that at least 90% of the studies I read include insufficient, inaccurate, or simply no history. It's a huge joke in radiology, but it's pretty sad too. Sometimes we can recreate the clinical scenario if we have access to notes, labs, etc., but - again - that's a rarity in my experience.

In the worst cases, we do incomplete or incorrect studies, like when ortho ordered a knee MRI the other day for "patellar tendinopathy". Come to find out that the guy was s/p ACL recon with hardware in his knee. We would have done extra sequences on a different field-strength magnet if we had been given that history. But we're too busy to track down every ordering provider whenever we need more information, so we adopt the "garbage in, garbage out" approach.

While I can sympathize with getting garbage from an imaging report, it strikes a nerve with us when we hear a clinician complaining about not getting much information from the radiologists when we are so frequently handicapped by the converse.

This might actually mean something to me if I were to ever receive a call/page from a radiologist looking to do the "right study." It seems to me that radiologists are often very willing to just go throught the motions with $1000 imaging studies and just blame the clinician (ie "Well, the stupid clinician just said headache." "Garbage in / garbage out").

I do feel there are many areas of medicine that could go without the radiology report, but tradition and attempts to spread the risk of litigation will likely prevail. (For example, does the orthopoedic surgeon really need your report in planning to repair a complex fracture - I hope not. If so, radiologists should start going to the OR an assist in the surgery planning / surgery). Does the neuro-surgeon really need you to find the SAH for them?

When I am in our neuro-ophthalmology clinic (academic institution), I am impressed with the discussions we have with our neuroradiologists as they know their stuff and can provide differential diagnoses for tumors and we can have intelligent discussions about the impact lesions can have clinically. However, the reads of about 90% of outside studies make me think someone, again, is just going through the motions - lots of buzz words and a differential diagnoses that sometimes makes no sense and it often ends with the infamous "clinical correlation indicated."

In summary, I like radiologists and see the value they often add. Just as we clinicians need to communicate better with you, radiologists should also communicate with the clinician.

 

[colbgw02]

This might actually mean something to me if I were to ever receive a call/page from a radiologist looking to do the "right study." It seems to me that radiologists are often very willing to just go throught the motions with $1000 imaging studies and just blame the clinician (ie "Well, the stupid clinician just said headache." "Garbage in / garbage out").

I do feel there are many areas of medicine that could go without the radiology report, but tradition and attempts to spread the risk of litigation will likely prevail. (For example, does the orthopoedic surgeon really need your report in planning to repair a complex fracture - I hope not. If so, radiologists should start going to the OR an assist in the surgery planning / surgery). Does the neuro-surgeon really need you to find the SAH for them?

When I am in our neuro-ophthalmology clinic (academic institution), I am impressed with the discussions we have with our neuroradiologists as they know their stuff and can provide differential diagnoses for tumors and we can have intelligent discussions about the impact lesions can have clinically. However, the reads of about 90% of outside studies make me think someone, again, is just going through the motions - lots of buzz words and a differential diagnoses that sometimes makes no sense and it often ends with the infamous "clinical correlation indicated."

In summary, I like radiologists and see the value they often add. Just as we clinicians need to communicate better with you, radiologists should also communicate with the clinician.

Agreed. But I can't tell you how much time I waste trying (unsuccessfully usually) to get people on the phone. A lot of that has to do with the system I'm in, but the phenomenon is pretty universal. On the other hand, I'm usually in the same place, and I will always stop whatever I'm doing to answer a provider when they call to ask "how do a best evaluate [blank]?"

Another issue that others have mentioned is how busy radiologists typically are, especially in private practice. If I called the clinician for every time I saw an order with insufficient information, then I would do nothing else all day long. It's not realistic to expect us to call everyone from whom we need more information. I know some practices have someone solely dedicated to getting people on the phone to free up time for the radiologists, which I think is a fantastic idea, but even then that's typically for conveying urgent results and not to protocol studies.

And let's not pretend that we don't have a little bit of a conflict of interest here. If someone orders an inappropriate study that has no hope of answering the question asked, then we'll just read the study, recommend the better study, and get paid for both.

 

[200UL]

colbgw02 - I appreciate your honesty, but there is no other field in medicine where the excuse "It takes too long - so I won't do what do what is best for patient care."

I realize the requesting physician is the one that created the problem -by ordering bogus studies/incorrect studies/and not giving you the needed data.

However, physicians that see patients in clinics have this occur all day - inappropriate consultations / lack of a complete medical record / patients who are poor historians. Instead of just blamming the patient or referring doctor, we simply make calls "all day" and hire assistants to gather information "all day". Wasteful, frustrating, but again - "I'm too busy" to figure out what is going on does not cut it for clinicians and surgeons.

I am hopeful your third point is a rare approach among radiologists - I hope I am never in a position where I must do inappropriate testing/treatment to make my salary - especially if what I am doing may subject patients to some risk (radiation/contrast reaction)......

 

[APDoc]

colbgw02 - I appreciate your honesty, but there is no other field in medicine where the excuse "It takes too long - so I won't do what do what is best for patient care."

I realize the requesting physician is the one that created the problem -by ordering bogus studies/incorrect studies/and not giving you the needed data.

However, physicians that see patients in clinics have this occur all day - inappropriate consultations / lack of a complete medical record / patients who are poor historians. Instead of just blamming the patient or referring doctor, we simply make calls "all day" and hire assistants to gather information "all day". Wasteful, frustrating, but again - "I'm too busy" to figure out what is going on does not cut it for clinicians and surgeons.

I am hopeful your third point is a rare approach among radiologists - I hope I am never in a position where I must do inappropriate testing/treatment to make my salary - especially if what I am doing may subject patients to some risk (radiation/contrast reaction)......

I agree with these sentiments 100%. Sure, I'd love to make more money by seeing more patients and doing more procedures each day, but that doesn't mean I'm going to ship patients out the door with a sub-par management plan just so I can "move on to the next one."

Ethics > Profits. Otherwise, you are just destroying the medical profession, and part of the problem rather than the solution.

 

[colbgw02]

So I had this relatively long reply, and after awhile I realized that I'm just not going to be able to explain things to my satisfaction. Radiology is fundamentally different than the specialties who are ordering the studies, and trying to conflate frustrations and solutions between the two just won't work. I'll just leave it at this: I'm not particularly happy about the excesses that I see in medical imaging, but I'm convinced that the radiologists are not the root cause and most of us would readily go along with some reform if anyone else would ever be inclined to do so.

 

[DrGregoryHouse]

Now on my second month of radiology. All the residents and attendings agree that the job market is tight at the moment.

I suspect that the market will improve dramatically soon. Eventually the old guard of radiologists will retire as the boomers hit 65. Many have decided to keep working because their 401k's tanked. Radiologists tend to work much longer than other physicians (second only to pathologists). Even so, the current generation of radiologists must eventually retire. And when they do, the job market will hit full speed. Also, the economy will recover one day, hopefully due to the winds of political change.

 

[gluon999]

Now on my second month of radiology. All the residents and attendings agree that the job market is tight at the moment.

I suspect that the market will improve dramatically soon. Eventually the old guard of radiologists will retire as the boomers hit 65. Many have decided to keep working because their 401k's tanked. Radiologists tend to work much longer than other physicians (second only to pathologists). Even so, the current generation of radiologists must eventually retire. And when they do, the job market will hit full speed. Also, the economy will recover one day, hopefully due to the winds of political change.

Agreed, by the time the current group of interns and junior residents graduate in 4-5 years, things should be looking better and brighter as the oldies head off into retirement (for real, this time). I think the job market should be wide open, assuming all other variables remain relatively stable.

 

[C5toC9]

What about the impending huge reimbursement cuts in imaging services?

 

[bronx43]

What about the impending huge reimbursement cuts in imaging services?

This is the biggest threat to the status quo of radiology. It won't derail the field, per se, but I can't imagine it remaining nearly as lucrative.

 

[C5toC9]

it has to have some significant effect on the competitiveness of the field / job market. also, the ongoing turf wars over interventional procedures with individual medical specialties.

 

[Holderlin]

Now on my second month of radiology. All the residents and attendings agree that the job market is tight at the moment.

I suspect that the market will improve dramatically soon. Eventually the old guard of radiologists will retire as the boomers hit 65. Many have decided to keep working because their 401k's tanked. Radiologists tend to work much longer than other physicians (second only to pathologists). Even so, the current generation of radiologists must eventually retire. And when they do, the job market will hit full speed. Also, the economy will recover one day, hopefully due to the winds of political change.

This makes me lol for some reason considering the amount of discussion about their inflated compensation.

"Oh no, my 401k went down to 10 million. Now I have to look at images for another 10 years"

lulz

 

[ringhal]

This might actually mean something to me if I were to ever receive a call/page from a radiologist looking to do the "right study." It seems to me that radiologists are often very willing to just go throught the motions with $1000 imaging studies and just blame the clinician (ie "Well, the stupid clinician just said headache." "Garbage in / garbage out").

This comment has several uninformed presuppositions. First, we radiologists generally do not have time pre-screen each request before the study is performed. So what we get is a completed exam with a grossly inadequate and/or inappropriate indication. In that scenario, it is easier to dictate the brain MRI ordered for "back pain" than to track down the ordering physician to find out why the study was actually ordered.

Second, we do not get reimbursed for inappropriately ordered exams. Private practice rads do them to keep the referrals from the clinicians who order them. Typically, rads in private practice get reimbursed for about 30-50% of the studies that are performed.

(For example, does the orthopoedic surgeon really need your report in planning to repair a complex fracture - I hope not. If so, radiologists should start going to the OR an assist in the surgery planning / surgery). Does the neuro-surgeon really need you to find the SAH for them?

This is a straw man argument. The neurosurgeon is not the person ordering that head CT - it's the ER. And yes, they may need my help finding it. Second, I know ortho doesn't need my help seeing the shoulder dislocation; they need my help seeing the spiculated mass sitting in the lung apex adjacent to the shoulder dislocation.

 

[Samoa]

Even a neurosurgeon would at least look at the official read for a study, because it's the radiologist's read that determines what findings the neurosurgeon would be held liable for treating (or not treating). The neurosurgeon might not agree with the read, but would need at least to be aware of it, and to document a different interpretation in the medical record, if it affects the plan of care. I can hear the lawyer now: "Doctor, are you saying you DIDN'T EVEN LOOK at the radiologist's report? The radiologist, who is trained specifically in the interpretation of medical imaging?" That would be hard to defend, regardless of the neurosurgeon's expertise in reading their own films.

 

[C5toC9]

how often does that actually happen? people think up these hypothetical situations and i know it is legit and could imagine it happening, but how often really in everyday practice?

 

[ringhal]

how often does that actually happen? people think up these hypothetical situations and i know it is legit and could imagine it happening, but how often really in everyday practice?

At least once a month I see a serious incidental finding - lung CA on a shoulder series, a renal mass on an L-spine MRI, pancreatic CA on a chest CT. These are more than hypothetical situations but it's not daily or even every week.

 

[Taurus]

If you have a shortage, it means salaries will stay the same or go up.

Report: Radiology may face supply gap in coming decade

Demand for radiologists is expected to exceed supply by 8 to 16 percent over the next 10 years, according to a report by physician recruitment firm LocumTenens.com.

The analysis—which includes information regarding trends in workforce growth, radiology salaries, productivity rates, teleradiology, practice management companies and legislative changes over the last decade— also offers a prediction of the future of radiology for the coming decade.

Since 1997, annual procedures per radiologist have increased 16 percent (from 12,800 procedures per radiologist, up to 14,900), despite increases in vacation time used (45 percent jump; up from 27 days in 1995 to 39 days in 2007) and decreases in the number of hours worked per week (down from 57 to 50 hours). The report attributed the productivity increases to advances in PACS and imaging technology. In addition, the forecast noted that the radiology workforce has increased approximately 25 percent over the past 15 years, with approximately three quarters of radiologists working in sub-specialty areas, due to the changing technical landscape of the field.

Despite increased productivity and additional radiologists, “supply will continue to be an issue in the coming decade,” the report predicted. “A shortage similar to the one at the beginning of the century is possible by the end of the next decade [and] mounting frustrations with Medicare/Medicaid policy and an improving stock market could be the final impetus that drives still-active retirement age radiologists to hang up their lab coats for good.”

Additional factors contributing to the shortfall as noted by the report, included:

* Radiology will be faced with more pressure with the implementation of healthcare legislation—including the HITECH Act and Patient Protection and Affordable Care Act (PPAC).
* When PPAC’s 75 percent utilization rate assumption goes into effect, low volume imaging centers will close as reduced technical component payments go into effect.

Factors that can stimulate demand include the newly insured having disproportionately high demand for services, aging baby boomers taxing the system more than expected and Medicare cuts. The report suggested that the potentially growing demand can be met by increasing residency slots at quicker rates, extending radiologist work hours or delaying retirement by one to two years.

Teleradiology uptake in the past decade has also risen dramatically, with 67 percent of radiology practices reporting the use of teleradiology services by 2003. Moreover, the report predicted that teleradiology will continue to be an important aspect of how radiology is practiced over the next ten years, helping to cover call and supplement radiology deficits in rural settings.

“What we can expect is greater use of teleradiology, improvements in productivity rates beyond their current levels and compensation packages that will continue to attract medical students to radiology residencies,” the report concluded.​

 

[bronx43]

If you have a shortage, it means salaries will stay the same or go up.

Report: Radiology may face supply gap in coming decade

Demand for radiologists is expected to exceed supply by 8 to 16 percent over the next 10 years, according to a report by physician recruitment firm LocumTenens.com.

The analysis—which includes information regarding trends in workforce growth, radiology salaries, productivity rates, teleradiology, practice management companies and legislative changes over the last decade— also offers a prediction of the future of radiology for the coming decade.

Since 1997, annual procedures per radiologist have increased 16 percent (from 12,800 procedures per radiologist, up to 14,900), despite increases in vacation time used (45 percent jump; up from 27 days in 1995 to 39 days in 2007) and decreases in the number of hours worked per week (down from 57 to 50 hours). The report attributed the productivity increases to advances in PACS and imaging technology. In addition, the forecast noted that the radiology workforce has increased approximately 25 percent over the past 15 years, with approximately three quarters of radiologists working in sub-specialty areas, due to the changing technical landscape of the field.

Despite increased productivity and additional radiologists, "supply will continue to be an issue in the coming decade," the report predicted. "A shortage similar to the one at the beginning of the century is possible by the end of the next decade [and] mounting frustrations with Medicare/Medicaid policy and an improving stock market could be the final impetus that drives still-active retirement age radiologists to hang up their lab coats for good."

Additional factors contributing to the shortfall as noted by the report, included:

* Radiology will be faced with more pressure with the implementation of healthcare legislation—including the HITECH Act and Patient Protection and Affordable Care Act (PPAC).
* When PPAC's 75 percent utilization rate assumption goes into effect, low volume imaging centers will close as reduced technical component payments go into effect.

Factors that can stimulate demand include the newly insured having disproportionately high demand for services, aging baby boomers taxing the system more than expected and Medicare cuts. The report suggested that the potentially growing demand can be met by increasing residency slots at quicker rates, extending radiologist work hours or delaying retirement by one to two years.

Teleradiology uptake in the past decade has also risen dramatically, with 67 percent of radiology practices reporting the use of teleradiology services by 2003. Moreover, the report predicted that teleradiology will continue to be an important aspect of how radiology is practiced over the next ten years, helping to cover call and supplement radiology deficits in rural settings.

"What we can expect is greater use of teleradiology, improvements in productivity rates beyond their current levels and compensation packages that will continue to attract medical students to radiology residencies," the report concluded.​

Sorry, but that's just untrue. Supply and demand might play a partial role in the determination of hospital-employed positions, but by far the biggest contributor to compensation for a certain medical field is the reimbursement it receives from various payers. Furthermore, there will be a shortage for the vast majority of specialties in medicine (in fact, I have yet to read about a projected surplus in any field), yet I wouldn't expect salaries to go up across the board. The most likely scenario is that medicine will continue to be bearish for the next decade or more, with certain specialties taking bigger hits than others.

 

[fun8stuff]

Sorry, but that's just untrue. Supply and demand might play a partial role in the determination of hospital-employed positions, but by far the biggest contributor to compensation for a certain medical field is the reimbursement it receives from various payers. Furthermore, there will be a shortage for the vast majority of specialties in medicine (in fact, I have yet to read about a projected surplus in any field), yet I wouldn't expect salaries to go up across the board. The most likely scenario is that medicine will continue to be bearish for the next decade or more, with certain specialties taking bigger hits than others.

The simple truth of the matter is that the physical exam is dead and will mostly soon be forgotten. Physicians will continue to rely and turn to radiology for an objective diagnosis (or at least a differential), rather than waste time examining the patient. Any medical student can tell you that there is a large part of medicine that basically depends on asking the patient what is wrong, ordering the particular test, and waiting for the radiologist/pathologist/computer to tell you what the problem is and then provide the cookbook solution.

The point is that the future of medicine lies in the objective diagnosis and minimally invasive treatment of disease- which matches a radiologists job description.

 

[bronx43]

The simple truth of the matter is that the physical exam is dead and will mostly soon be forgotten. Physicians will continue to rely and turn to radiology for an objective diagnosis (or at least a differential), rather than waste time examining the patient. Any medical student can tell you that there is a large part of medicine that basically depends on asking the patient what is wrong, ordering the particular test, and waiting for the radiologist/pathologist/computer to tell you what the problem is and then provide the cookbook solution.

The point is that the future of medicine lies in the objective diagnosis and minimally invasive treatment of disease- which matches a radiologists job description.

That's great, but not exactly what I'm talking about. I admit that radiology will continue to be a staple in Western medicine, and won't lose demand in the long run. However, that doesn't mean that it'll stay as lucrative as it currently is, as the reimbursement rates for diagnostic imaging will be drastically cut. I'm also not buying the increase in demand due to population pressures, because that tidbit is true across the board for the vast majority of specialties - an aging population necessarily equals a population in need of more health care.

 

[Taurus]

Sorry, but that's just untrue. Supply and demand might play a partial role in the determination of hospital-employed positions, but by far the biggest contributor to compensation for a certain medical field is the reimbursement it receives from various payers. Furthermore, there will be a shortage for the vast majority of specialties in medicine (in fact, I have yet to read about a projected surplus in any field), yet I wouldn't expect salaries to go up across the board. The most likely scenario is that medicine will continue to be bearish for the next decade or more, with certain specialties taking bigger hits than others.

I'm trying to stay optimistic. Don't pop my bubble yet.

No one knows how the future will shape up. Salaries probably will go down across the board in all specialties. But who knows for sure. They were predicting gloom and doom for medicine in the early 90's. That's why you had an exodus of applicants from anesthesiology and radiology in the mid 90's. But the predictions proved wrong and salaries were as strong as ever from the late 90's up to now. Whatever people do, make sure you will enjoy doing it for the next 30 years. I know I could never do primary care for 30 years.

 

[bronx43]

I'm trying to stay optimistic. Don't pop my bubble yet.

No one knows how the future will shape up. Salaries probably will go down across the board in all specialties. But who knows for sure. They were predicting gloom and doom for medicine in the early 90's. That's why you had an exodus of applicants from anesthesiology and radiology in the mid 90's. But the predictions proved wrong and salaries were as strong as ever from the late 90's up to now. Whatever people do, make sure you will enjoy doing it for the next 30 years. I know I could never do primary care for 30 years.

Yeah, that's the main point I am trying to make. Do what you like, because going into something for the money is an idiotic move, considering the likelihood of change in the future. And I'm not really making a definitive statement on the future of radiological reimbursement rates. You're right in that no one can know for sure, but I was responding more to the notion that supply and demand was somehow going to keep incomes up. It's not. If radiology remains a lucrative field (which is unlikely), it'll be due to the government failing to cut reimbursement for diagnostic imaging.
I personally think this time change is coming for real, but either way, it shouldn't really factor into someone's choice in picking a specialty.

 

[penguin24]

Yeah, that's the main point I am trying to make. Do what you like, because going into something for the money is an idiotic move, considering the likelihood of change in the future. And I'm not really making a definitive statement on the future of radiological reimbursement rates. You're right in that no one can know for sure, but I was responding more to the notion that supply and demand was somehow going to keep incomes up. It's not. If radiology remains a lucrative field (which is unlikely), it'll be due to the government failing to cut reimbursement for diagnostic imaging.
I personally think this time change is coming for real, but either way, it shouldn't really factor into someone's choice in picking a specialty.

You're right, but I wanted to add that going into a specialty without considering the money is also an idiotic move. One must take into account interest in the field and financial considerations. Just like nobody can predict the stock market, nobody can predict future physician reimbursements.

 

[2012mdc]

Yeah, that's the main point I am trying to make. Do what you like, because going into something for the money is an idiotic move, considering the likelihood of change in the future. And I'm not really making a definitive statement on the future of radiological reimbursement rates. You're right in that no one can know for sure, but I was responding more to the notion that supply and demand was somehow going to keep incomes up. It's not. If radiology remains a lucrative field (which is unlikely), it'll be due to the government failing to cut reimbursement for diagnostic imaging.
I personally think this time change is coming for real, but either way, it shouldn't really factor into someone's choice in picking a specialty.

Money should definitely be a factor just not the most important factor. But hypothetically if someone is considering path and rads and for whatever reason path was a lot more lucrative and secure it would be foolish not to consider it.

As medical students it is hard to be absolutely set on just 1 field based off how much we enjoyed it in limited exposure plus do we feel it fits our goals, personality etc. IMO - enjoyment of the field is the obvious #1 factor but lifestyle and then money must be given serious thought too.

On a somewhat related side note, would IR be majorly affected (or affected at all) by diagnostic imaging cuts?

 

[dopetown]

This is the biggest threat to the status quo of radiology. It won't derail the field, per se, but I can't imagine it remaining nearly as lucrative.

how severe do you guys predict cuts to be? it looks like the average is around 400-500k. do you expect it to go down to, what, 100-200k?

 

[bronx43]

Money should definitely be a factor just not the most important factor. But hypothetically if someone is considering path and rads and for whatever reason path was a lot more lucrative and secure it would be foolish not to consider it.

As medical students it is hard to be absolutely set on just 1 field based off how much we enjoyed it in limited exposure plus do we feel it fits our goals, personality etc. IMO - enjoyment of the field is the obvious #1 factor but lifestyle and then money must be given serious thought too.

On a somewhat related side note, would IR be majorly affected (or affected at all) by diagnostic imaging cuts?

It's harder to say when IR will be cut, as many of their procedures aren't diagnostic imaging per se (just image guided). It's my personal conclusion that the range in discrepancies between incomes in different specialties will be much smaller within the next decade. Just how small the range is will be told by time, but I seriously don't see any non-surgical field making 400k+.

 

[bronx43]

how severe do you guys predict cuts to be? it looks like the average is around 400-500k. do you expect it to go down to, what, 100-200k?

No one knows, but I don't think it's dire to the point where radiologists would make 100k. If I had to guess, I would say mid-200k would be reasonable for a prediction.

 

[tennischamp822]

.

 

[bronx43]

^ bronx, are you saying that radiologists in the US will be making less than radiologists in Canada (who make 300-400k on average today)???

I agree there will be cuts, but I was thinking more in the 20% range which would bring down salaries to the Canadian range...

I'm not sure I follow this logic. What does the incomes of Canadian radiologists have anything to do with cost cutting of diagnostic imaging in the US?

 

[tennischamp822]

.

 

[bronx43]

They aren't directly related, but I question how you came up with your salary prediction.

All I am saying is that if Canada can afford to pay its radiologists 350k, why can't the US match that salary (considering we spend much more on healthcare every year)?

Because it's far more complex than just country A spends more on health care, therefore doctors in country B will necessarily make less money. Canada is a different country with a different health care system. Reimbursement rates are different, and there are different players in the health care industry. There are plenty of specialties in Canada that makes more than their American counterparts, and the opposite is also true.
I don't really know how low radiology reimbursement will get, but a simple 20% reduction in reimbursement corresponds to a much bigger drop in compensation, as costs won't be proportionally cut.

 

[fun8stuff]

Because it's far more complex than just country A spends more on health care, therefore doctors in country B will necessarily make less money. Canada is a different country with a different health care system. Reimbursement rates are different, and there are different players in the health care industry. There are plenty of specialties in Canada that makes more than their American counterparts, and the opposite is also true.
I don't really know how low radiology reimbursement will get, but a simple 20% reduction in reimbursement corresponds to a much bigger drop in compensation, as costs won't be proportionally cut.

you both are likely equally right because nobody knows and i am guessing you both don't have the experience or qualifications to even hazard an educated guess.... or at least not more than the other. If you have some secret source, please cite your references. Inquiring minds would like to know.

 

[bronx43]

you both are likely equally right because nobody knows and i am guessing you both don't have the experience or qualifications to even hazard an educated guess.... or at least not more than the other. If you have some secret source, please cite your references. Inquiring minds would like to know.

Yeah... that's why I made the disclaimer that my opinion is simply an opinion. A poster asked, so I offered it with the admission that the future cannot be definitively predicted by anyone. And the suggestion that any "experience" or "qualification" in radiology offers one the ability to do so is just asinine.

 

[badasshairday]

With the tightening job market, are fellowships becoming harder to get? I know right now, if you really want a certain fellowship, you can get it. Will this change in the future? Especially with IR?

I'm really thinking seriously about Radiology -> IR as my career choice and thought that the hard part would be getting into radiology residency. I know we can't predict 5 years into the future, but does anyone has some insight into this? It seems like a lot of radiology residents don't really care for the IR lifestyle currently... but could changes in radiology compensation make IR more competitive again? Seems like a lot of people go into radiology thinking IR, but then don't think it is worth the lifestyle to make a similar or slightly higher income. Also, I mean, I like DR, but I can't imagine my whole life doing it. It would be a bummer if I couldn't match into IR in the future. I've been interested in surgical subspecialties and cards/GI, but IR is the most innovative and awesome field!

 

[penguin24]

IR is not hard to match into. The hard part is matching into DR residency, and even that isn't too bad. Almost everybody is doing fellowships now, so it's not possible for fellowships to be more competitive than they already are.

 

[myhandsarecold]

was told by an ophthalmologist that imaging is going to be outsourced soon, and he was even comfortable with that idea

 

[Holderlin]

I don't like this thread

 

[LuckyST]

was told by an ophthalmologist that imaging is going to be outsourced soon, and he was even comfortable with that idea

I highly doubt that this will ever happen. There are literally dozens of layers within the American healthcare system, as well as the American medical-legal system, which guarantee that medical care needs to be provided by physicians who are board certified in the United States. It is very hard to imagine this changing anytime in the near or distant future.

If Radiology can be outsourced, so can about a dozen other medical professions. Instead of pathologists reading slides in the hospital, those slides could be sent digitally to a pathologist in India. Instead of a family doc (or a neurologist, ophthalmologist, PCP, cardiologist, etc) seeing a patient in clinic, you could have an NP see a patient, and then consult with a physician from India over video conference. It is hard to imagine any of this happening without a complete revolt from the AMA, as well as the American public.

 

[youngdoc8205]

I heard from a radiologist that optometrists are going to start doing LASIK

I heard from a surgeon that CRNAs are going to start running SICUs

I heard from an internist that physical therapists are going to start doing joint replacements and speech pathologists are going to start putting in PEG tubes

I heard from a CRNA that they are going to start running SICUs :-D

The only outsourcing going to happen in radiology is already happening, to teleradiology groups (still in the USA) and I think the trend is swinging the other way because it turns the field into a commodity/lab test rather than a consulting specialty. Also there things that have to be done in person IR/flouro/biopsies/ultrasound.

 

[bronx43]

I highly doubt that this will ever happen. There are literally dozens of layers within the American healthcare system, as well as the American medical-legal system, which guarantee that medical care needs to be provided by physicians who are board certified in the United States. It is very hard to imagine this changing anytime in the near or distant future.

If Radiology can be outsourced, so can about a dozen other medical professions. Instead of pathologists reading slides in the hospital, those slides could be sent digitally to a pathologist in India. Instead of a family doc (or a neurologist, ophthalmologist, PCP, cardiologist, etc) seeing a patient in clinic, you could have an NP see a patient, and then consult with a physician from India over video conference. It is hard to imagine any of this happening without a complete revolt from the AMA, as well as the American public.

Obviously, if you take it to the extreme, you can make the argument that every specialty can be outsourced, but radiology and pathology are two fields that are far more likely to be replaced by foreign labor than patient-facing specialties like primary care or any medical or surgical subspecialty. The fact that radiology and pathology have little to no patient contact means that they are entirely subject to their employers as far as any business trends. Yes, the current system is jammed tight with legal quagmires, which ultimately maintains the status quo. But, that doesn't mean it'll remain that way, especially in economic crises and longterm downturns that this nation will face in the upcoming years. All doctors seem to clamor for tort reform, but if it actually came about, which fields would benefit?

 

[Taurus]

Radiology is recognizing the threat from teleradiology and changing accordingly. The future is that radiology will be 24/7 inhouse attending coverage -- at least in the inpatient setting. Right now, the model is that the vast majority of attendings and residents go to work 9 to 5 and then you have 2 residents cover nights and weekends. The weak coverage at night and weekends by residents is what drove the demand for teleradiology attending reads. The new model is attendings and residents will come in according to shift which will be staggered so that you get 24/7 attending coverage. When this happens, there will be less demand for teleradiology.

 

[colbgw02]

Radiology is recognizing the threat from teleradiology and changing accordingly. The future is that radiology will be 24/7 inhouse attending coverage -- at least in the inpatient setting. Right now, the model is that the vast majority of attendings and residents go to work 9 to 5 and then you have 2 residents cover nights and weekends. The weak coverage at night and weekends by residents is what drove the demand for teleradiology attending reads. The new model is attendings and residents will come in according to shift which will be staggered so that you get 24/7 attending coverage. When this happens, there will be less demand for teleradiology.

This only applies to academia, which is a very small part of healthcare in the U.S. When people talk about becoming a commodity and teleradiology, it's private practice that's driving the train.

As best as I can tell, teleradiology developed because there was a very small window in time where the study volume went through the roof, reimbursements were still high, and the technology allowed rapid online transmission of studies and reads. The result was the average radiologist got sick and tired of working his butt off only to have to take call as well. For awhile, it was cost-effective to pay someone else a percentage of the professional reimbursement to at least provide a preliminary read (and sometimes a final read).

Reimbursements have gone down, and they probably will continue to do so. It's not nearly as cost-effective as it once was to pay someone else to read a study, especially if the read is only a preliminary and has to be over-read in the morning (e.g. Nighthawk or any other overseas service).

My guess, and it's only that, is that we're reaching some sort of equilibrium vis-a-vis teleradiology. Radiologists are only willing to work so hard, but the number of imaging studies performed continues to go up. Unwilling to cede territory, private practice groups will continue to offer overnight coverage. Ergo, teleradiology will remain alive and well, but it won't take over the field as so many uniformed non-radiologists seem to think. I also suspect that we'll see an increasing number of teleradiologists hired on as FTEs or even put on a partnership tract.

Besides, ordering providers almost universally prefer to have a radiologist in the flesh with whom to interact. Radiologists are finally recognizing this, which will further temper the expansion of teleradiology.

 

[myhandsarecold]

thank god. i almost vomited when he said that, which is funny because he does a lot of telemedicine himself (PA or NP takes pictures of fundi and sends it to him for a read). either way, i dont see myself doing any clinical stuff so even if salary plummets for DR, i'd probably still do it (i hate microscopes and most people!!!)

 

[LuckyST]

Obviously, if you take it to the extreme, you can make the argument that every specialty can be outsourced, but radiology and pathology are two fields that are far more likely to be replaced by foreign labor than patient-facing specialties like primary care or any medical or surgical subspecialty. The fact that radiology and pathology have little to no patient contact means that they are entirely subject to their employers as far as any business trends. Yes, the current system is jammed tight with legal quagmires, which ultimately maintains the status quo. But, that doesn't mean it'll remain that way, especially in economic crises and longterm downturns that this nation will face in the upcoming years. All doctors seem to clamor for tort reform, but if it actually came about, which fields would benefit?

I'm not sure that I follow your logic. If it were only the legal system preventing the outsourcing of Radiology reads, then you would expect countries all over Western Europe (which don't have these "legal quagmires") would be outsourcing their reads. But they aren't. There are many, many, many other obstacles to outsourcing. Just to give a few examples:

-how do you think that the AMA would react to the outsourcing of Radiology reads overseas?
-how do you think the American public would react to know that Indian Radiologists are reading their head CTs?
-who would do all of the procedures? Radiologists do image-guided biopsies, angiograms, flouroscopic procedures, barium enemas, etc, which would be impossible to outsource
-if an Indian doctor is allowed to read images, how can you stop an Indian doctor from coming to the United States (not board certified) and practice in any other specialty (primary care, neurology, surgery, etc)?

My argument is: this isn't likely to ever happen. To the best of my knowledge, it has not happened in any other industrialized country. The only way it would ever happen is if the governing bodies in radiology allowed foreign medical graduates to make reads (which they never will), the medical-legal system completely transformed (which it never has), the American public became completely apathetic (unlikely), and the AMA and all other physicians stopped caring about future of American medicine (hopefully, this will never happen).

 

[badasshairday]

Obviously, if you take it to the extreme, you can make the argument that every specialty can be outsourced, but radiology and pathology are two fields that are far more likely to be replaced by foreign labor than patient-facing specialties like primary care or any medical or surgical subspecialty. The fact that radiology and pathology have little to no patient contact means that they are entirely subject to their employers as far as any business trends. Yes, the current system is jammed tight with legal quagmires, which ultimately maintains the status quo. But, that doesn't mean it'll remain that way, especially in economic crises and longterm downturns that this nation will face in the upcoming years. All doctors seem to clamor for tort reform, but if it actually came about, which fields would benefit?

Oh give me a break. There are around 27,000 practicing radiologists in the United States, population 300,000,000.

There are 6,000 radiologists in India, population 1,000,000,000. How many of them are board certified to practice in the USA, very few. Even if all 6000 of them became board certified and read the studies, their is no way they could read them all. In a highly specialized field like radiology, there is a limited global supply of radiologists. This limits the ability for outsourcing of radiology. This isn't some call center service field that anyone can do.

BTW, radiology is one of the most competitive specialties in India. My cousin is a radiologist in Mumbai, and his pad and lifestyle is better than that of radiologists in the USA. So they make pretty darn good money reading Indian films anyways.

 

[200UL]

There will always be a place need for us radiologists but salaries will drop-just like all of medicine.
I actually believe Canada will ultimately be a better environment to practice medicine for many fields. Why? The big cuts have not hit US medicine yet. There are many forces acting against doctors when the big cuts hit ( industry, Pharos, hospital lobby, insurance companies... Even the patiens think doctors make way to much). Canada has already made many cuts - they obvious know how how to negotiate drug prices according to my patients.

There is only so much pie to go around-there will be many changes on who gets what in the future.

 

[DrVanNostran]

There will always be a place need for us radiologists but salaries will drop-just like all of medicine.
I actually believe Canada will ultimately be a better environment to practice medicine for many fields. Why? The big cuts have not hit US medicine yet. There are many forces acting against doctors when the big cuts hit ( industry, Pharos, hospital lobby, insurance companies... Even the patiens think doctors make way to much). Canada has already made many cuts - they obvious know how how to negotiate drug prices according to my patients.

There is only so much pie to go around-there will be many changes on who gets what in the future.

When people say "big pay cuts," what do they exactly mean? From what I am reading, I am hearing between 16-25%. I know that we have a tremendous amount of variables, but any educational guesses?