Month: September 2021

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New Tax Laws Cancelling The Backdoor Roth IRA- A Major Loss For Radiology Residents!

backdoor roth IRA

Debt, burnout, declining reimbursements are some of the issues new radiologists need to face. But, yes, the hits keep on coming. Now, new radiologists also have to contend with a potential loss of the Backdoor Roth IRA. Again your future has just become murkier.

Right now, in Congress, Senators and representatives are duking it out over taxes and how to raise money for a multi-trillion-dollar spending bill. One of the line items on the agenda is the cancellation of the Backdoor Roth IRA, as the public perceives it as a tool for the rich to save on taxes. So, what exactly is a Backdoor Roth IRA, and how will this affect you? And, most importantly, what you can do to help to stop it.

What Is A Backdoor Roth IRA?

Let’s first start with what a Roth IRA is. A Roth IRA, which many of you know, is a post-tax account that accumulates tax-free for the rest of your life. Most residents should put as much into this account right now while they have a low salary and are underneath the income limits. The Roth account allows any future earning on this money to grow tax-free in perpetuity, even when your income climbs as an attending.

A Backdoor Roth IRA is also a Roth IRA. But most radiologists cannot put money into a Roth IRA directly because there are income limitations (you need to make below 140,000 as a single filer and 208,000 as a married filer in 2021). 

However, there has been a loophole. Any high-income earner can first put money into a Traditional nondeductible IRA and immediately convert it to a Roth IRA. Now, you essentially have the same Roth IRA as any earner below the limits has. 

Why Is/Was It Such A Great Option For Radiologists?

I have been using this savings vehicle since we were allowed to start in 2010. It has allowed for outsized tax-free earnings on money that I have put in the account. Not having this account would have significantly negatively impacted my savings. It is truly one of the last tax breaks for high-earning professionals like radiologists.

Because of the power of compounding, the younger you are, the more beneficial the account is. So, any resident should be concerned about Congress eliminating this Backdoor Roth IRA because it impacts you more than someone like me who has already been depositing into this account for years.

Moreover, you never had to pay another dime of taxes on the money you put inside the account. Granted, at present, it is only 6000 dollars per individual or 12,000 dollars for a couple. But, that number rapidly increases over time with the tax-free earnings and rising yearly contributions pegged to inflation. Over the long run, it was an excellent tool for avoiding tax drag on your accounts.

Finally, some radiologists may be in a high tax bracket when they retire because they may have most of their savings in 401k type accounts. It allowed for some money not to be taxed and hedged your bet about future taxes and earnings on your withdrawals.

What Can You Do Prevent Congress From Cancelling The Backdoor Roth IRA?

Every radiology resident should be writing to their congressman and asking them to refrain from canceling the bill. You have so much debt. You don’t start earning real money until late in life. And, you have been taking on the burden of Covid. I see this as a stab in the back for all future high-earning physicians. Of course, radiology residents are not a large bloc of citizens. But, every person counts. So, consider writing to your congressman to add to the lobbying in your congressional districts!

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Working From Home: A Difficult Dilemma For Radiology Practices

from home

Since Covid began, almost all practices have established a teleradiology presence from home. But, it is a work in progress. Some radiologists still need to man the forts, especially in hospital and imaging center-based practices. Contrast issues, treatments, complex studies such as cardiac CTAs, and on-site ultrasounds still involve a radiologist on-site. And many practices have been struggling to figure out the right mix. This dilemma leads to problems with structuring rotations, compensation, and making the staff happy. Therefore, I will discuss the most significant issues practices face and potential solutions to the most critical problems. I will divide these into rotations, compensation, and personal staff issues,

Rotation Problems Caused By Working From Home

Setting rotations to staff the practice from home versus in-house adequately can be daunting. Some radiologists typically have expertise in areas more conducive to work at home. Others need to be in the department more often. These lead to inherent problems of inequity and jealousy. So, setting up appropriate rotations to equalize home rotations can be very difficult. In addition, technologists and nurses need to be in contact for occasional events like contrast reactions and when to do so. If you create new rules, you must ensure the staff understands who to get and when.

To create equity, you have to recognize the following facts. First, only some people can work from home all the time in a non-teleradiology practice. And then, some specialties allow radiologists more freedom to work at home. Once we recognize these inherent problems with total equity and fairness, we can create rotations to equalize some of these issues. For instance, the practice can make some of the in-house rotations “easier” to compensate for inequities within the practice partially. Or, you can make some rotations on-call rotations. These are just simple ways to relieve some of the problems of unfairness among the staff.

Compensation 

Should employees and partners receive the same compensation if they can do more at home? Is there an upcharge or premium for having to come in more often? These potential inequities in the fairness of compensation also lead to other problems. Some procedures you can read at home pay more per unit worked (MRI) than others involving in-house work (IR). How do you account for that when you compensate your radiologists for their work?

Well, there are a few simple models. First, you can make all work equal with the philosophy that all work is valuable to the practice regardless of the reimbursement. It would help if you had the low RVU fluoroscopers as much as the high revenue MRI readers because they all provide a helpful service. This philosophy works much better in a partnership. In addition, you can provide more revenue and moonlighting opportunities to increase income for radiologists who are more interested in making some extra money. These opportunities help out a bit.

You can also decrease pay for radiologists who only work by teleradiology since they do not provide the same on-site services, such as management of contrast reactions, consults, and procedures. A practice can adjust the rate depending on the time worked outside the office compared to an “average” practice radiologist.

Either way, these models provide some equity for the practice.

Personal Staff Issues

Finally, you have issues such as radiologists who have extenuating circumstances. You may have new mothers or radiologists who temporarily need to move far from the practice, and so on. Sometimes, you need to make accommodations for individual radiologists so they can continue to work. Again, compensation needs to reflect the amount of time that these radiologists work outside the office and the need for the radiologist once they return. 

Working From Home: Not All A Bed Of Roses

On an individual basis, working from home can be a godsend. What’s better than being present at home with kids, dogs, spouses, contractors, and more? On the other hand, from a practice perspective, working from home introduces many additional problems. Fairness/equity of rotations, compensation issues, and individual staff issues are just some of the problems that group leaders need to contend with. Practices can work out most of these kinks. But getting the right mix takes a bit of effort and creativity. Having all radiologists working from home is more complex than it seems!

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9-11: Now And Then: A Radiologist’s Perspective

9-11

9-11 is one of a few days frozen in time for my generation. For the Baby Boomers, it was also the assassination of JFK and the landing on the moon. But for us, it was this day. Most of us remember exactly where we were and what we were doing at the time on this twentieth anniversary. So, like many, I have been reflecting on my experience, the meaning of 9-11, and how the world has changed. For radiology, in particular, the technologies since that time have significantly evolved. The attitude/culture of physicians and patients have transformed. And, the general sense of security and well-being is no longer the same.

It turns out that on 9/11, I was amid my radiology residency as a 3rd-year resident. And, so I will share my own experiences of what happened while I was working as a radiology resident on that fateful day. And, then I will shift gears toward the seismic changes that we have experienced over the past 20 years in radiology since that day.

My 9-11 Experience

Ironically, that morning, I donned a gown and was helping out with thyroid biopsies on my ultrasound rotation at Rhode Island Hospital. As the procedure ensued, at some point, a medical student walked int0 the room and exclaimed, “An airplane hit one of the world trade centers!” My first thoughts were about how that made no sense. Maybe he had gotten something wrong. So, within a few more minutes, we completed the biopsy, and I walked toward the patient TV area to see for myself. There was a jumble of confusing voices on the TV screen with the pictures of the first world trade center alight with billowing dark smoke. They said that a plane had hit the tower, but no one was certain if it was a terrorist attack or an accident.

Affixed to the TV screen, watching the first trade tower live, all of a sudden, the cameras shifted to the second tower, which was now also on fire. At this initial time, the cameras did not catch the second plane hitting the building. It took some time to figure out that another plane crashed the second world trade center. And, then the secretary called me into the following procedure as I was concerned about friends that I knew that worked near the area in Manhattan. It was a harrowing experience completing the ultrasound procedure, not knowing what was happening in Manhattan at the time.

Eventually, I found out that everyone I knew that might have been in or near the towers was alright. One friend who was a resident physician in medicine had tried to help out downtown, but the officials turned him away. After the incident, some other friends I knew had started their long trek to leave Manhattan from their jobs. And a family member was on the road at the time, nestled in traffic and watching the billowing smoke from the trade centers from afar. Fortunately, that was the closest that I had come to the 9/11 incident.

Nevertheless, the nonstop drumbeat of media reports issuing terrorist threats would continue over the next several weeks and months. And, you could not watch TV the constant replay of the videos of the trade centers. There was a perpetual reminder of the incident for a long time.

Some Of The Changes For Radiologists Since 9-11

Travel– (To And From Conferences)

Most notably for radiologists, the way we travel and getting back and forth to conferences has become a little more involved. 9/11 spurred the development of the TSA. Shampoos and drinks all had to be small in size to get on the plane. Lines have become longer, and we now have to leave much sooner to the airport to get there on time. And, air travelers are a little bit more irritable than ever before, both from the long lines and from thoughts about the terrorist attacks on 9-11.

Technology:

A lot has changed over the past 20 years, yet much has stayed the same. The bare bones of the hardware, including ultrasound, CT, MRI, and PET scans, were available at the time. But, the applications have since multiplied. PET-CT was more of a research tool at the time. It came into its own a few years later. But, FDG was used.

Applications of Technology

MRI and CT

Body MRI and MSK MRI is much more common today than it was back then. Now we order MRIs on all the joints routinely. Back then, it was a bit more sparingly used. Larger institutions were introducing CT applications such as Chest CTA for pulmonary embolism due to the faster speed of the scanners. . Having a sixteen multidetector or more CT scanner was a big deal back then. And only specific experienced radiologists could read them.

PET/ PET-CT

Pet scanner applications were much more limited by medicare/insurance reimbursement. Medicare and insurance companies would only pay for lung cancers, solitary pulmonary nodules, and several other indicators. You had to pay for others out of pocket if you wanted it done. And, as mentioned above, PET-CT and its applications mainly were a research tool with a lot of debate whether it was better than PET!

Ultrasound

We used breast ultrasound primarily for diagnostic purposes at that time. Most institutions would perform breast ultrasounds only sparingly for screening. For better or for worse, screening ultrasounds have become much more part of our culture.

PACs

PACs machines were not yet ubiquitous. Fifty percent of institutions had them back them. And, they were much slower than they are today, with more crashes and less flexibility. (Although not all these issues are resolved!)

General Attitude of Physicians, Patients

Now, this part might be a bit controversial. Some of you might think that what I will describe happened before 9/11. And others might feel a bit differently. But, I believe this event contributed, at least in part, to the tribalistic nature of our society today. Everyone had differing strong feelings about what happened and who was responsible. And everyone retreated to their tribe. Republicans and Democrats became more fixed in their thoughts, unwilling to compromise or hear the other side. And, this event along with social media, was one of the foundations for this shift in attitude and politics. 

Changes After 9-11: A Mixed Bag

Of course, 9-11 and the ensuing days were a rough time. But, some good has happened since. The adaption of new technologies has increased radiology’s footprint in medicine over the past twenty years, probably for the better. Yet, the decreased ease of travel and the new tribalistic attitude of patients and physicians has partially counteracted some positives.

The base notion about 9-11 is that it is one of those days that have shifted everyone’s lives in one way or another. The world and radiology will never be the same!

 

 

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Are All Radiologists Destined To Have Chronic Back Pain?

back pain

After walking my dog a while back and pulling a back muscle (thankfully, I recovered), I started to think about the risk of lower back pain and radiology. Am I more prone than others to having back issues? What are the chances that I can permanently have back pain from my day-to-day work? And, are the risks related to what kind of radiology you practice?

According to the literature, if you are a radiologist who sits and reads lots of films from a PACS workstation or an interventionist who always wears lead shielding and does procedures, your back may not thank you. Based on reality in the field, the human body was not meant to sit for many hours or stand in one place with heavy weights. So, let’s drift into the nitty-gritty data on radiologists and back pain. Then, we can discuss some standard solutions to remediate our woes.

The Hard Data About Radiologists And Back Pain

Here is some of the information to support these radiology-specific related back issues. In one study in the JVIR, the mean prevalence of the general population was around 31 percent for everyone. Then, when you look at the radiology community more specifically, you even get more stark statistics. Within the interventional radiologist population alone, 20.1 to 24 percent have back and neck pain limiting work. Additionally, the same study reported a prevalence of lower back pain in the general radiology population of 52 percent and back and neck pain in interventional radiologists at 60.7 percent. If you believe this study, the prevalence of back pain in radiology is nearly double the general population. This number is not small. It is the majority of us!

Another JVIR article states that the prevalence of back pain gets worse with age, especially among those who complete interventional procedures. (We all have something to look forward to!) That makes sense because of the extra weight that interventionists need to bear. The only saving grace is that radiologists have less back pain than nurses and techs. But that does not change the fact that we have a very high prevalence of back pain as radiologists.

The Only Solution: Prevention!

The last thing that radiologists want to do is get into a situation where you need back surgery. We all know that is the last resort. Heck, many of us read many spine X-rays and MRI horror shows. Some of the solutions espoused in the JVIR papers are reasonably simple. Taking a break is the best plan of action. If you notice that your back is beginning to hurt, you must take a break. Repetitive motions can exacerbate back pain. Exercises involving strengthening the back muscles may prevent significant injuries.

Others are more immediate and easy to do, including lifting slowly, sleeping on your side, and avoiding rapid bending movements. Stretching can also potentially prevent some forms of back injury (I’m a big proponent of this one!)

Finally, ergonomics helps with the situation. That means appropriately positioning equipment and monitors, back supporting seats, clearing the floors of obstructions, and custom-fitted garments for the interventionists among us.

Let’s Face It: Chronic Back Pain Is The Radiologist Bugaboo!

For surgeons, needle stick injuries are a big concern. For psychiatrists, their most significant issue is mental wear and tear. But we, as radiologists, face chronic back pain as our most prevalent job hazard. Furthermore, based on my recent back issue and this short survey of the literature, we need to take the prevention issues seriously. As the old Benjamin Franklin quote goes, an ounce of prevention is worth a pound of cure. Don’t let your imaging centers and hospitals convince you otherwise!