Month: November 2022

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Radiology Practices Feeling The National Radiologist Shortage Crunch!

shortage crunch

I can’t speak for everyone. But, nowadays, most practices throughout the country feel the pinch of an acute radiologist shortage crunch. For those on the job seeker’s side, the news right now is a mixed blessing. It is excellent for those of you searching for a job. But, once you set your career path, you may notice longer-term issues until the crisis resolves. Here are some of the problems you may encounter once you start working.

New Radiologists Making More At The Expense Of Future Earnings

Most of you probably see some of the advertisements for new radiologists on the web. Starting salaries of 400,000, 500,000, or more are not uncommon. But all this money needs to come from somewhere. Well, it is coming out of the pockets are practices, hospitals, or corporate radiology, to meet the coverage needs of the radiology work that needs completion. It just means that new radiologists are less likely to see the more significant raises they typically get when they achieve parity with the partners or own shares in the practices. Every dollar comes from somewhere!

Larger Stipends From Hospitals Means Increased Dependency

The lack of radiologists also means that hospitals are committed to ensuring that radiologists stay in the fold. Commonly, hospitals are issuing increasing stipends to practices throughout the country. Unfortunately, this process increases the dependency of radiologists on the hospital and not their work. So, when conditions change (and they certainly will at some point!), it can make it all the more painful when hospitals pull the rug out from the radiologist and stop issuing stipends upon leaner times. Eventually, hospitals are more likely to be able to take over lesser well-run practices. Too much dependency on other institutions is not ideal for the solvency of radiologists in the long run!

Unending Work And Shift Coverage

Sure, extra work is great when you are starting and are hungry for more business and money. But as you get along over time, the extra work is not so desirable. Many of you will likely have families and other obligations to which you will attend. Nevertheless, the streams of work keep on flowing to no end. And who will be covering all this work? Most likely you, whether you like it or not!

Shortage Crunch Increasing Long-Term Competition And Midlevels

I’m all for physician assistants, nurse practitioners, and other mid-levels to help the radiologist. However, suppose radiologists cannot meet the demands of the radiology world. In that case, different professionals will likely replace our roles due to a lack of ability to meet the needs of today’s imaging. These include increasing independent procedures and reads performed by these helpers. In addition, it also makes us more likely to lose work to other physicians. Cardiologists, urologists, and neurologists are just some physicians who would be happy to take over some of our business. Over the long run, this situation does not bode well for radiology practices.

More Films Going Unread And Increasing Liability

With the inability to command more staffing, more films will go unread. Patients will have more complications from a lack of appropriate imaging workups. And this can all lead to increased liability for radiology practices that are obligated to read all the films promptly. An incomplete workforce of radiologists hampers medical care and increases the potential for lawsuits!

The Shortage Crunch Continues! 

Although I do not have a crystal ball, I don’t see an abrupt end to this acute radiologist shortage crunch; The imaging loads increase every year with new technologies and the increasing age of our population. The numbers of new radiologists are not significantly increasing to meet the demands. And it takes ten years to create new radiologists starting from the beginning of medical school, so creating more radiologists is like turning a large aircraft carrier- it takes forever. Moreover, based on recent experiences with artificial intelligence, it has not replaced us or made us significantly more efficient. If these trends continue, we will continue to dive into the abyss of a shortage crunch. Good news, we’ll all be in high demand. Bad news, these pressures will probably continue for years to come!

 

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Not Sure What You Want? Private Practice, Hospital Based, Or Academic Residency: Find A Radiology Program With All Three!

not sure

Usually, I’m not particularly eager to toot my own horn. But, with the new merger of our three residency programs, we have established a unique situation that very few programs throughout the country can boast. Residents can now experience what it is like to work as a trainee in private practice, a practice with radiologists directly hired by a hospital, and an academic hospital, all under the roof of one residency program. Why is this situation so helpful for residents who have graduated from a program like this? Well, if you are not sure now, later, it can minimize the chances that, as a new hire, you will pick the wrong career path. And that decision can be challenging. Let me explain why.

Not Sure? Pick Among All The Experiences!

Private Practice Experience 

Welcome to our world. When you attend a residency with a private practice-based mentality, the program becomes very different than a standard residency program. Private practice’s priority is getting through a significant number of cases daily. Every study you read is extra cash in the group’s pocket (and yours too if you are a partner) So, we need to complete all the work as soon as possible. So, the main goal is to maximize efficiency. If you have a residency program associated with a private practice, you will see how this way of thinking affects your faculty. Around ninety percent of radiologists eventually go into some form of private practice. So, you must discover what you are in for when you get out of training! (Most residents have no idea!)

Hospital Based Experience

This experience is the most common for radiology residency programs. The typical structure is that the hospital hires individual radiologists. Perhaps, they have some form of incentives for efficiency, teaching, and participation in hospital committees. But, radiologists don’t get a specific piece of the professional or technical fee action. So, these hospital-based groups are more aligned with the needs of the hospital than the needs of the other partners. Therefore, in most of these sorts of practices, there is only a monetary incentive for getting the work done, no more than what the individual hospital contract asks. If there are no riders for reading other films, most likely, these employees will not read them without additional incentive. This structure causes a different mentality than the typical ownership mentality of private practice. Yet, it does have some alignment with the standard private practice in terms of primary efficiency goals.

Government/Academic Experience

Here is the typical large university center structure. In this structure, your salary is more based on academic achievement than efficiency for reading films. You get your raises and your bonuses based on academic grant production, teaching residents, and giving lectures at conferences throughout the country. Attendings in the situation will align with some private entities they are researching. And they will get some form of a stipend for studying their equipment, drugs, procedures, etc. Academic practices often do not incentivize efficiency as much as the other models. This mentality is not the real world for most radiologists, but those intellectual sorts will live like this. Some love the academic experience; others do not so much!

Not Sure? With A Wealth Of Different Residency Experiences, The World Is Your Oyster

Finding a residency program that encompasses all three experiences, private practice, hospital-based, and academic, allows the resident participant to get a feel for the world post-residency in most potential career paths. If I had such an opportunity, I probably would have stuck to one job post-residency because I would have known the practice scenario I would have wanted. So, if you have the rare opportunity to get a residency spot that allows you to experience all three ways of working, seriously consider it over others. It’s a great way to avoid the wandering situation where you work at multiple practices until you find the right one!

 

 

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Why Working From Hawaii Doesn’t Work For Most Of Us!

Hawaii

“The best laid plans of mice and men often go awry” is a famous quote that cannot be more true for us radiologists. I’m sure many of you have thought about what it would be like to work from a tropical island like Hawaii to read teleradiology cases several weeks out of the year in practice. Doesn’t sound too bad? How about reading evening studies and frolicking on the beaches with a Mai-Tai in hand in the daytime? Well, sorry to be the bearer of bad news; I will have to squash that thought for most of you. And here are some of the most likely reasons it won’t work.

It’s Still Relatively Easy To Hire Tele-radiologists

Although it is more expensive than a few years ago, if a practice has to choose between hiring overnight teleradiologists or a nighthawk and paying for a place in Hawaii for radiologists to read 6 hours every day, it is a lot less expensive to hire the overnight radiologist. Paying for a home for radiologists can be costly. And not everyone may want to go!

Not Everyone Can Get To Hawaii From Practice 

Believe it or not, if you create an outpost for radiologists to practice on a tropical island, not all of them can pack their bags and go. Some have families, and others have obligations that root these radiologists to the motherland. It is just not easy to get there for everyonee.

Additional IT Headaches

When creating a new outpost, you must ensure it runs well. The last thing a practice wants is a malfunctioning PACS system in a faraway outpost. That burden means the imaging business must pay for excellent IT support. And, with IT support comes additional expenses to maintain the site. Moreover, if the site goes down, other radiologists in the hometown will have to come to the hospital in the wee hours.

Billing Problems

Although not a complete game changer, with all the other issues, the location of dictations can create a headache for billing. Insurance companies do take into account the locale of the dictations. And this can make the process somewhat harder to get reimbursed. Let’s just add-on another issue to the whole!

Not Everyone Likes The Beach In Hawaii

Although going to Hawaii every once in a while to read some cases may sound great, not everyone loves the beach. Yet, your group will have to flip the bill for this privilege. Working from a beach location means you have to like crystal clear water and coconuts. What floats your boat may not be attractive to everyone!

Time Of Working May Not Be Optimal 

The time difference of 6 hours is not a reversed schedule. That means that when you go to bed at 10 PM EST, it is 4 PM in Hawaii. So, if you want coverage from 10 PM until 8 AM EST, you must go to work from 4 PM to 2 AM in Hawaii. Although better than working entirely overnight, it is not perfect for many radiologists. Some radiologists are early birds!

It Takes A Bit Of Extra Effort

Finally, creating another outpost outside your location takes some work and time. And most radiologists don’t want to have to deal with extra burdens. So, although it may be nice in theory, in practice, there are lots of other issues to worry about, first and foremost!

Nice Thought, But Hawaii Probably Will Not Happen In Your Practice!

Sorry to burst your bubble. I didn’t mean to put a kibosh on your hopes and dreams. Nevertheless, we need to be realistic. As you can see, all the headaches you need to work from Hawaii will probably not be worth the effort. Although a great idea, in theory, that’s another story in practice. If you like Hawaii, you may have to go there on vacation or work in Hawaii as your primary job!

 

 

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A Review Of Med School Insiders Insights Into Radiology

med school insiders

If you are like me, I am an avid youtube fan. Since it is in my wheelhouse, one of the topics I occasionally search for is radiology (in addition to astronomy, Ukraine, and guitar lessons!). And as I was surfing the YouTube world on these topics. I hit upon a series of videos with the hypnotic voice of Dr. Jubbal from Med School Insiders, a business that caters to students who want to enter the field of medicine. Many of these videos claimed to review Radiology as a field, including salaries, types of residents, the culture, and more. But does that mesmerizing voice have it all right? Or, is much of what Dr. Jubbal says about radiology a farce? Here is a review of the world of Dr. Jabal, and Med School Insiders impression of the field of radiology and whether he gets it all right.

Salaries- In The Middle Of The Pack?

The videos emphasizing radiology talk about salaries and consistently talk about radiology as somewhere in the middle of the pack. That phrase can be very misleading. As someone within the field, knowing where we stand in the salary ranking, I know that salary is highly dependent on where you work, whether you are in private practice or academics, and a slew of other factors. Based on my own experiences with these factors, radiology has been more consistently toward the top of the salary distribution on average than most other specialties. But, of course, it is possible to find a lower-paying radiology job.

Med School Insiders Talk About Artificial Intelligence

This factor is where Dr. Jubbal gets it wrong. He uses artificial intelligence as a risk for new students entering radiology. Artificial intelligence has consistently been underwhelming for most radiologists out there as a way to replace radiologists. The best CAD detectors for mammo and lung nodules have consistently underperformed expectations. The biggest problem with artificial intelligence is that there are always new data sets that the researchers have not inputted into their algorithms. And, any independent reads by a computer will not be able to take these myriad factors into account for a very long time. I don’t see any chance of it taking over a radiologist’s job for more than fifty years from now.

Even if artificial intelligence becomes more successful, radiologist numbers  are still way too low relative to the amount of work out there. Artificial intelligence may even boost efficiency to get more done in less time, enabling radiologists to do more with less and increase earnings. (That would be a good thing) Artificial intelligence, therefore, is not much of a risk at all to the profession. Sorry, Jabal!

ROAD/Flexibility

Dr. Jabal constantly adds radiology as part of the lifestyle specialties. Sure, we have one of the most flexible specialties regarding work location, shiftwork, and type of work. However, many of us have become insanely busy because we are replacing a lack of physician staffing elsewhere, i.e., emergency medicine, family medicine, etc. For this reason, patients will often get pan-scans without being seen by clinicians first. So, many of us have become very busy trying to keep up with the demand. So, I’m not sure we belong on the ROAD list anymore!

More Introverted Specialty

On this subject, I would have to agree on a bit. Although I know lots of radiologists who are very outgoing and personable, many radiologists would prefer to work alone as well. In other specialties, this introversion does not fly as well when you have to see tens of patients daily—seeing patients could become exhausting for an introvert. Radiology is a way to avoid the constant bombardment of patient contact. (Of course, it does not have to be that way!)

Competitiveness

Here is another area where I would have to agree with Dr. Jabal. Although the trends have become more competitive lately since COVID, we are certainly not as competitive as dermatology or orthopedics. We place somewhere in the middle of the pack, maybe a bit more toward the upper end of the mid-tier lately. Dr. Jabal seems to emphasize a similar level of competitiveness, somewhere toward the middle of the middle, That ranks close enough to the mark.

Doctor Jubbal, Med School Insiders, And Radiology

So, yes, Dr. Jubbal does toot his own horn as he had formerly trained as a plastic surgeon and subtly suggests that plastic surgery is the epitome of being a physician. If you can get past that, he does get some impressions of radiology right, especially the appeal to introverts and the general competitiveness of radiology. On the other hand, he misses the mark a bit for others, such as salaries, artificial intelligence, and the ROAD concept for radiology. But, overall, he does not do so badly. His youtube segments are enjoyable to listen to and can help residency applicants in general. My advice, though, is never to use one source for anything. And try to find mentors in the residency space within your specialty of interest. The best advice will come from physicians within the area of training where you want to apply!