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Right, bc I'm sure lots of people would do 12 plus years of training for the same amt of money that they could get with a PA/CRNA, mid level or nursing or even MBA. Whatever.
Radiology
- Thread starter Zumba
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Right, bc I'm sure lots of people would do 12 plus years of training for the same amt of money that they could get with a PA/CRNA, mid level or nursing or even MBA. Whatever.
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So what's the point with tele rads? Don't you still have to hire rads? So wouldn't it make more sense to hire on site rads? Or is the whole tele rads movement meaning as in foreign or abroad tele rads?
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deleted103644
No. I'm not referring to foreign services that can only provide preliminary reads.
Domestically trained radiologists licensed in the states whose studies they read. They can be reading from abroad, but they all complete US residency programs.
They can provide final reads, although as Drizz implied, currently they've been scraping the bottom of the barrel and deliver crappy service.
With the job market right now, they're getting a more talented pool of recruits and improving their business models.
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Excuse me being naive but why is working as a tele rad so bad? If US trained peeps are being hired what's so wrong with that? Sorry if the question is stupid.
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You have to work at night only unless you're abroad.
I think people are not going to use telerads for anything except overnights. It's just too much of a problem liabilitywise.
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deleted103644
You're working for a lot less with no partnership track and little job security.
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deleted103644
Why is it a liability problem with US licensed teleradiologists?
Obviously groups wouldn't use them for anything else but nights and weekends, but the hospitals are realizing they might as well do it 24/7.
I'm not 100% on how the financial stuff works with technical/professional fees, but teleradiology is clearly able to provide lower costs.
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So are you suggesting that there would be no on site rads in hospitals if hospitals went the telerads way? That would not seem practical or logical. And even if they did that why would it pay less? And if it did pay so poorly why would people continue to go into rads then?
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deleted103644
There would need to be onsite IR, but there's no good reason for IR an DR to remain the same specialty.
Because the big teleradiology corporations do not offer partnership tracks to their physicians (usually). You're just reading studies. Reimbursement is weird though so I don't have a full handle on how it works yet, but if it were a normal marketplace the answer would be obvious - competition between national companies to keep costs down and profits up.
They won't unless they really like it.
You seem primarily motivated by money. Radiology is probably not your best choice.
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Money like with everything is part of choosing a specialty, and reason why rads was so competitive until recently. Take the money out of any competitive specialty and you have primary care. No preaching needed. And reason why rads had a ton of unfilled spots last year - cocnern about market and lower $$$$. No one wants to work like a dog to get paid like primary care. And if I was solely motivated by money which I am not, rads until recently would have been one of the best bang for your buck specialty.
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deleted103644
Predicting future salaries is a fool's errand. You are setting yourself up for disappointment.
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None of us can really predict anything but discussing it makes sense though IMO.
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deleted103644
Good luck.
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Thank you.
Whatever you say is what you've heard on some random forum. It is obvious that you are not a resident or practicing radiologist.
IMO, teleradiology will become less and less popular. First, what a DR does is more than film reading. Most clinicians want to know who is reading their studies. In most hospitals with telerad, clinicians are not happy.
With increasing volume of studies, sooner it will justify to have a radiologist on call to work the whole night. My current group was covered by teleradiology before, because it did not make sense to have one person on call to read 2 CTs the whole night. Now with increasing volume and some added studies from evening, we have a night shift that makes sense financially.
Currently we are in a transition era. The reason that non-partnership pays really low, is becuase the money goes to the partners. So if I work 5 bucks which is what medicare pays for a chest portable, I get paid 2 bucks because 3 bucks goes to the senior partner. The same for teleradiology, they pay 2 bucks because 3 bucks goes to telerad admin. Now if we go towards the employment model, which we are going, the partner will not exist anymore. Then if I make 5 bucks, I will be paid probably 4 bucks becuase one will go to the hospital. The senior partner will also get paid 4 bucks, which is much lower than his prior income which was 8 bucks ( 5 bucks for his work plus 3 bucks out of my work). The tele group also can not exist unless they pay me 4 bucks which is not justifiable for them.
Anyway, I myself see a much brighter future than what people say. The volume is going up and we are becoming more dependent on imaging. More and more high end studies are coming from primary care doctors. The income will drop Significantly for senior partners ( see above why) and some of it will go to new graduates. We will not see radiculously high incomes. More senior people will retire as a result and the jobs will open.
The main reason that the market is tight is not the volume. I can clearly see the need. For example my current group needs at least two more people, but we work our a.. Off, because the seniors want to make the most out of it before health care reform implemented.
And one more thing, current radiology condition is bad for new graduates and is still great for senior partners. The trend of events is in great favor of new graduates and is greatly against senior partners. As a result new graduates complain of their current job and seniors talking about doom and gloom of the future. This has resulted in a general negative image of radiology.
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deleted103644
I don't have a negative image of radiology (and your guess about me was wrong), just don't think the private groups can continue to compete vs teleradiology for much longer. I agree that the employee model is the future for those who work at large hospitals, but smaller hospitals probably will go with teleradiology.
I agree that jobs will get better in the next few years, but I think you're wrong on the long term trends with teleradiology. Whenever someone says that people are happier talking to a real person in house, they are usually wrong - doesn't particularly matter which field, it is a pattern that has happened many times already and will happen again many times in the future.
If you read my prior post, I clarified my point.
Telerad beats partnership model of radiology and it is more justifiable finacialy for the hospital to give the business to telerad and not the current group.
BUT, telerad is a loser compared to employment model. Rather than giving the money to telerad company and also the expenses of maintaining the telerad system, the hospital admin puts the money in his pocket and gives a better package to radiologist. In the long run, this results in a more stable model with more satisfied everybody. And not surprisingly, it is what is happening now.
If you are doing radiology residency with a dream of doing telerad, it will not grow in the future, IMO.
In pp, clearly it is very important to surgeons to know who is reading their study before operating. I've heard many times from orthopods that this shoulder is probably OK, because the MRI was read by Joe who tends to overcall SLAP tear.
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cowme
The future of teleradiology is going to be PP groups hiring "night radiologists" as partners. They will probably continue the 7on/7off schedule to keep it desirable, and still be able to work from home (except the rare instances where they're needed in house overnight). They'll be able to keep their profits in house, ensure continuity of care, and pay the "teleradiologist" more as well.
Major tele companies covering hospitals in 20 states, however, is probably a dying breed.
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deleted103644
Heh, "dreams of doing teleradiology"? Not quite. I don't dream, but if I did, I'd hope they'd be better than that...
Planning on academic (ie employment model) or interventional (can't do tele-procedures, at least not yet).
IR can not be replaced by Tele, but can be replaced by vascular surgeons. Good Luck.
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deleted103644
So far leaning away from IR, but thanks.
Don't jump down my throat since we basically agree that PP is dead. I never said tele would replace employment model rads.
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in my opinion, radiologists should go to clinicians during rounds and offer their services - even on films that already have a final read. this increase in facetime is big-time value added and results in better patient care and a future for onsite radiologists and puts teleradiology at a disadvantage.
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deleted103644
Absolutely. And this will continue to be true at academic centers.
But the same could have been said of pathology.
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er.. yeah no.i dont think i want "rounds with clinicians"
there are always new scans coming it and i dont want to stand around somewhere waiting to see if people have questions when i could be doing work. if they have questions, they know EXACTLY where to find radiolgoists.
its not like they need to go searching for us like i remember doing when i needed to find where the cardiolgoists were currently at.
there are always new scans coming it and i dont want to stand around somewhere waiting to see if people have questions when i could be doing work. if they have questions, they know EXACTLY where to find radiolgoists.
its not like they need to go searching for us like i remember doing when i needed to find where the cardiolgoists were currently at.
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I agree, that's the purpose for conferences and tumor boards... Rounding would be inefficient.
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deleted103644
Yeah, I thought he meant the physicians coming to the reading room for rounds.
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so back in the good ol' days (im told) clinicians would come to the radiology dept to read scans alongside a radiologist because x-rays and scans were printed on film and it was quicker to go down and read with a radiologist than to wait and have the film sent up to the floors ....
while in the dept of radiology, clinicians would ask questions about films and radiologists would ask questions about the patient.. the two would interpret the films and the two would arrive at a diagnosis. clinicians learned something about radiology and radiologists learned something from the clinician - not only the history of the patient that they were interpreting films on, but about the clinical practice of medicine (which, i think, helped with future cases)..... not to mention, radiologists demonstrated their value to the entire md profession
now, from what i've gathered from my limited clinical and radiology experience.... clinicians only come down to radiology if there is an outside scan to interpret without an official read.... if a clinician looks at a scan that theyve ordered and they see something funny, they think 'hey thats weird, i wonder why radiology didnt comment on that' and, often, they move on. this is bad for learning - i.e. future patients and worse for that patients care.......maybe it was something that the radiologist missed? maybe the clinician wouldve learned something new from a radiologist. heck, maybe the radiologist would've learned something from the clinician which would improve their ability to spot in the future
--
my point is that, in the grand scheme, the job of radiologist should not be to bang out studies as quickly as possible but to help interpret studies with clinicians for patients.
i think this is better done face-to-face... since clinicians are not coming to radiology, radiologists should go to them. do i think rounding for 3 hours with the medicine team is an effective use of time? no. but i do think that radiologists could show up at the beginning or end of interdisciplinary rounds and allow medicine teams to pepper them with imaging questions.... this 1 hour activity per day, i think, would serve the profession well by both furthering patient care and demonstrating value to the rest of the medical profession...
... but what do i know, im a medical student. its possible that ill have a paradigm shift while in residency and im actually doing radiology... but until then, i think that it seems like a pretty reasonable thing to do to help the profession survive the night-hawk and tele-radiology madness that ive been reading/hearing about...?
while in the dept of radiology, clinicians would ask questions about films and radiologists would ask questions about the patient.. the two would interpret the films and the two would arrive at a diagnosis. clinicians learned something about radiology and radiologists learned something from the clinician - not only the history of the patient that they were interpreting films on, but about the clinical practice of medicine (which, i think, helped with future cases)..... not to mention, radiologists demonstrated their value to the entire md profession
now, from what i've gathered from my limited clinical and radiology experience.... clinicians only come down to radiology if there is an outside scan to interpret without an official read.... if a clinician looks at a scan that theyve ordered and they see something funny, they think 'hey thats weird, i wonder why radiology didnt comment on that' and, often, they move on. this is bad for learning - i.e. future patients and worse for that patients care.......maybe it was something that the radiologist missed? maybe the clinician wouldve learned something new from a radiologist. heck, maybe the radiologist would've learned something from the clinician which would improve their ability to spot in the future
--
my point is that, in the grand scheme, the job of radiologist should not be to bang out studies as quickly as possible but to help interpret studies with clinicians for patients.
i think this is better done face-to-face... since clinicians are not coming to radiology, radiologists should go to them. do i think rounding for 3 hours with the medicine team is an effective use of time? no. but i do think that radiologists could show up at the beginning or end of interdisciplinary rounds and allow medicine teams to pepper them with imaging questions.... this 1 hour activity per day, i think, would serve the profession well by both furthering patient care and demonstrating value to the rest of the medical profession...
... but what do i know, im a medical student. its possible that ill have a paradigm shift while in residency and im actually doing radiology... but until then, i think that it seems like a pretty reasonable thing to do to help the profession survive the night-hawk and tele-radiology madness that ive been reading/hearing about...?
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newdoc, times have changed bro. When docs have questions they usually just call because it's easier and faster for everybody. Furthermore, computers have made things much easier and everyone can see the scans. Also to be frank it usually isn't necessary for either side to have a lot more information from the other. If the primary team feels the report is vague or doesn't adequately answer what they were looking for or have some other question that is what the phone is for. Radiologists are very good at giving differentials based on scans and the clinician can then include the report to narrow the differential. Plus in the age of electronic medical records the radiologist can look up clinical information if they feel it is necessary.
Are you really graduating in 2013? I'm just surprised because if so you would have seen all of this by now.
Are you really graduating in 2013? I'm just surprised because if so you would have seen all of this by now.
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newdoc, im sorry, but you sound a little ...young. are you graduating med school in 2013? or is that when you are starting?
the radiologist IS supposed to "bang out" studying because those patients' doctors need those studies read so they can continue treating the patient. Also, clinicians regularly come down to the radiology reading room in my institution. certain services, like surg onc, even have special designated times where they come down as a team to go over scan with the radiologist.
also, it makes no sense for radiologists to go to clinicians because the computers in the reading room are superior to the old computers clinicians use to write notes. the reading room computers are fancy and new and meant to view studies very well.
the radiologist IS supposed to "bang out" studying because those patients' doctors need those studies read so they can continue treating the patient. Also, clinicians regularly come down to the radiology reading room in my institution. certain services, like surg onc, even have special designated times where they come down as a team to go over scan with the radiologist.
also, it makes no sense for radiologists to go to clinicians because the computers in the reading room are superior to the old computers clinicians use to write notes. the reading room computers are fancy and new and meant to view studies very well.
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Nope graduating 2013. Guess we just have differing opinions.
well good luck then going around looking for physicians to explain the scans even when they have no questions. No one is going to go along with you in this regard. If you want more teaching responsibilities and not just "bang out studies" then stick to academics.
And also in the "Good old days" clinicians used to know about their patients. These days barely they have a good history. None of them have examined the patients.
Examples:
1- Abdominal pain is provided as clinical history. You call ED doctor to ask more. He says "Oh, I have not seen the patient yet."
2- Head MR to rule out stroke. you call neurology and he says "the patients feels weak on the right side and I ordered an MR."
These are very common. I used to call them and try to get more history. After doing it for a while, I found it pretty useless. Most do not know that much. many other know, but are busy with other patients.
This is the modern medicine. Many H&Ps are written after the patient is discharged. Esp with EMR, you do not have to write down the history. It is more copy-paste from PAs history. As a result you do not even remember what you put in your note. I myself always found medical students and interns the best people to know about the patient. In pp, clinical medicine does not exist at all.
Examples:
1- Abdominal pain is provided as clinical history. You call ED doctor to ask more. He says "Oh, I have not seen the patient yet."
2- Head MR to rule out stroke. you call neurology and he says "the patients feels weak on the right side and I ordered an MR."
These are very common. I used to call them and try to get more history. After doing it for a while, I found it pretty useless. Most do not know that much. many other know, but are busy with other patients.
This is the modern medicine. Many H&Ps are written after the patient is discharged. Esp with EMR, you do not have to write down the history. It is more copy-paste from PAs history. As a result you do not even remember what you put in your note. I myself always found medical students and interns the best people to know about the patient. In pp, clinical medicine does not exist at all.
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deleted103644
Not true at all, at least not with the old school guys who knew what they're doing.
My medicine preceptor was one of those old school cardiologists who could get a better diagnosis with just a stethoscope and a physical than most could get with an echo.
There was an art to the physical exam, but it has mostly been lost. Imaging makes a lot of it irrelevant, but don't mistake our relative incompetence at physical diagnosis due to reliance on imaging for a lack of utility in a proper physical.
I'm not really complaining about this shift because it will put bread on my table, but remember that just because you wouldn't be able to diagnose something with a physical alone doesn't mean that no one could.
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Oh really?
Might want to check this article out:
Kobal SL, Trento L, Baharami, S, et al. Comparison of hand-carried ultrasound to bedside physical examination. Am Jour Cardiol, 2005; 96: 1002-6
http://www.ncbi.nlm.nih.gov/m/pubmed/16188532/
Medical students with a couple hours training blew away board certified cardiologists in diagnostic accuracy and it wasn't even close.
Might want to check this article out:
Kobal SL, Trento L, Baharami, S, et al. Comparison of hand-carried ultrasound to bedside physical examination. Am Jour Cardiol, 2005; 96: 1002-6
http://www.ncbi.nlm.nih.gov/m/pubmed/16188532/
Medical students with a couple hours training blew away board certified cardiologists in diagnostic accuracy and it wasn't even close.
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deleted103644
Obviously I'm on the imaging side here, not saying all of the old guys could out perform an ultrasound, but a few almost could. My point was never that ultrasound isn't the future, just that some people were understating what can be found on a physical exam, mistaking their jack of ability for lack of utility.
It's a bit like John Henry I suppose - just because a few exceptional guys with great training could stand toe to toe with the machine doesn't mean the machine isn't the future.
Expect a similar comparison to show up when image recognition algorithms get better.
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The comparison is between people with no training with ultrasound against experienced board certified cardiologists. Put that US in an experienced operator's hands and they'd outperform a stethoscope every single time. The modalities are simply not comparable.
As far as CAD goes, that might be true in the future but probably a few decades away; I have a couple friends doing probably the most cutting edge CAD stuff (Mgh/MIT collab) and they don't think it's even close to ready.
As far as CAD goes, that might be true in the future but probably a few decades away; I have a couple friends doing probably the most cutting edge CAD stuff (Mgh/MIT collab) and they don't think it's even close to ready.
Obviously I'm on the imaging side here, not saying all of the old guys could out perform an ultrasound, but a few almost could. My point was never that ultrasound isn't the future, just that some people were understating what can be found on a physical exam, mistaking their jack of ability for lack of utility.
It's a bit like John Henry I suppose - just because a few exceptional guys with great training could stand toe to toe with the machine doesn't mean the machine isn't the future.
Expect a similar comparison to show up when image recognition algorithms get better.
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The problem with physical exam is not so much that it is always useless but that it is useless 80% of the time but you are expected to do it 100% of the time.
That means 80% of the time you spend writing "HEENT: NC/AT, EOMI, PERRL, anicteric sclerae, clear oropharynx..." could be put to better use actually thinking about the right diagnosis and treatment. It is more important in medicine to signal that you care and are conscientious then to actually care about the right diagnosis and treatment. That's what I hate about clinical medicine.
Radiology is a lot more pure. Yes there is filler but it is less involved then having to round on each patient and go through the motions of the physical exam in cases when it is very low yield.
That means 80% of the time you spend writing "HEENT: NC/AT, EOMI, PERRL, anicteric sclerae, clear oropharynx..." could be put to better use actually thinking about the right diagnosis and treatment. It is more important in medicine to signal that you care and are conscientious then to actually care about the right diagnosis and treatment. That's what I hate about clinical medicine.
Radiology is a lot more pure. Yes there is filler but it is less involved then having to round on each patient and go through the motions of the physical exam in cases when it is very low yield.
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deleted103644
The comparison wasn't my main point. I'm not arguing with you there.
Other people were saying the physical exam is worthless, and my point was that just because their physical exam might be worthless doesn't mean it's always the case.
I agree, think we're around 3 decades away from losing 2D images to the machines. 3&4D images will be lost a bit sooner since they're easier for the machines and harder for us. And you always have to account for unforeseen advances, so I'd wager 3 decades is the outer limit.
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45408
Disagree. For our surgical patients, it often helps a lot to call when we have a patient who has had numerous operations, especially if they're recent, to clarify how exactly someone's anatomy is now configured.
It's still vitally important in surgery. "Thickened bowel" on CT can be an anomaly or something physiologic like a peristaltic wave, or it can represent an ischemic segment. Your physical exam is often the way to distinguish the two.
There are plenty of things that can't be imaged or imaged well though. Skin changes, pulses, icterus, and the overall big picture of a patient (do they look sick?) are all still very important. We once had someone getting a duplex of the femoral arteries on a guy before they noticed his legs were cold and mottled. Hmmmm.
That's a bad, bad idea. I picked up a foreign body that the radiologist clearly missed, which required a repeat operation. I definitely brought it to his attention, and he acknowledged "Yup, that was a big miss on my part."
In brief, look at your patient, and do not get a study if it won't change your management of the patient.
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agree.
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1.
As an intern in the ER (I'm TY) I just found tremendous value this week calling the radiologist for a patient with acute RLQ pain, CT abd/pel was read as "normal appendix, fibroid uterus."
The read was technically correct, but kind of unsatisfying. We spoke over the phone, and I asked him if there was anything he could see that could cause this magnitude of pain. He re-opened the study and gave much more additional info, told me the fibroids were in fact hypodense, appeared to be degenerating, which thus could cause acute pain (he knew this from IR colleagues performing UFEs). He proceeded: the fibroids could've been stable until menopause, was the patient perimenopausal? (Actually, yes). Ultimately he changed our management. When our ER shift ended the patient was being properly seen by GYN, not general surgery like we were initially going to call.
My only pet peeve was the radiologist was teleradiology (afterhours), and the admin picking up the phone was quite the barrier. I had to insist three times I would like to discuss the case before he agreed to transfer me. He kept repeating, "The study has been officially read, you can always review the report online."
2.
As a med student at an academic medical center we had daily radiology rounds in peds and neurology. Very valuable swinging by the reading room as a team for a 20 minute discussion of 4-5 cases. Strengthened clinician/radiologist rapport as well. That's how I learned there can be much more to a study than the official read. Everyone enjoyed radiology rounds.
3.
No one likes teleradiology at my hospital. Some of our in-house radiologists call ER staff directly with all positive findings. We're running around like mad and not sitting around refreshing the results tab. This 8 second phone call speeds up patient dispo tremendously. Only 3 weeks into my ER rotation and I have found that I have already forged a personal relationship with the radiologists who call us (it helps if you tell them you're an intern going into rads). We greet each other by name. At times it almost became mindreadingly synergistic, like if they didn't call, we could assume a negative study. All the attendings/residents know them by name and gush about them. There will always be added value to having good in-house radiology.
As an intern in the ER (I'm TY) I just found tremendous value this week calling the radiologist for a patient with acute RLQ pain, CT abd/pel was read as "normal appendix, fibroid uterus."
The read was technically correct, but kind of unsatisfying. We spoke over the phone, and I asked him if there was anything he could see that could cause this magnitude of pain. He re-opened the study and gave much more additional info, told me the fibroids were in fact hypodense, appeared to be degenerating, which thus could cause acute pain (he knew this from IR colleagues performing UFEs). He proceeded: the fibroids could've been stable until menopause, was the patient perimenopausal? (Actually, yes). Ultimately he changed our management. When our ER shift ended the patient was being properly seen by GYN, not general surgery like we were initially going to call.
My only pet peeve was the radiologist was teleradiology (afterhours), and the admin picking up the phone was quite the barrier. I had to insist three times I would like to discuss the case before he agreed to transfer me. He kept repeating, "The study has been officially read, you can always review the report online."
2.
As a med student at an academic medical center we had daily radiology rounds in peds and neurology. Very valuable swinging by the reading room as a team for a 20 minute discussion of 4-5 cases. Strengthened clinician/radiologist rapport as well. That's how I learned there can be much more to a study than the official read. Everyone enjoyed radiology rounds.
3.
No one likes teleradiology at my hospital. Some of our in-house radiologists call ER staff directly with all positive findings. We're running around like mad and not sitting around refreshing the results tab. This 8 second phone call speeds up patient dispo tremendously. Only 3 weeks into my ER rotation and I have found that I have already forged a personal relationship with the radiologists who call us (it helps if you tell them you're an intern going into rads). We greet each other by name. At times it almost became mindreadingly synergistic, like if they didn't call, we could assume a negative study. All the attendings/residents know them by name and gush about them. There will always be added value to having good in-house radiology.
