Friday, January 28, 2011

Radiologist Salary Levels Affected By Medicare Changes?

According to a recent article in Medscape, nonradiologists are being paid more by Medicare for non-invasive diagnostic imaging:
January 6, 2011 — Nonradiologist physicians are now paid more by Medicare for noninvasive diagnostic imaging (NDI) than are radiologists, according to a study that appears in the January 2011 issue of the Journal of the American College of Radiology.

"Radiologists have always been considered the physicians who 'control' ...NDI and are primarily responsible for its growth," write lead author David Levin, MD, professor emeritus and former chair of the Department of Radiology at Thomas Jefferson University Hospital, in Philadelphia, Pennsylvania, and colleagues. "Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging."

To find out how actual Medicare dollars for NDIs are allocated, the study authors used Medicare Part B files to track overall payments to radiologists and nonradiologists from 1998 to 2008.

In 1998, payments to radiologists for NDIs were $2.563 billion, 27% higher than the $2.020 billion that went to nonradiologists, the researchers report. However, from 1998 to 2006, Medicare payments to nonradiologists increased by 166% vs 107% to radiologists. By 2006, nonradiologists were receiving more total payments than radiologists.

At the beginning of 2007, the Deficit Reduction Act of 2005 went into effect. The law, passed by Congress, was aimed at reining in Medicare and other government spending. By 2008, payments to radiologists had been cut by 13%, and nonradiologists took an 11% loss.

The article goes on to discuss how self-referral is one of the big drivers in this change in net revenues to nonradiologists, which makes sense. However, the statistics quoted are not necessarily relevant to the issues of radiologist salaries! Think about it: a percentage change depends on the level from which the statistic starts. Since radiologists in general earn about three times the annual salary of internists, a slightly larger cut in Medicare reimbursements is not actually leading to a lower salary for radiologists.

Second, there are many more nonradiologists in practice as compared to radiologists. There are a million practicing physicians in the U.S., but roughly only 50,000 radiologists, meaning there are twenty times as many non-radiologists! In other words, each radiologist is still getting a fairly large piece of the pie.

Lastly, the general increase in the amount of imaging is a major boon to radiologists, despite the increased workload. Even if nonradiologists are compensated for simple imaging, eventually some of that imaging will lead to the need for more complex imaging studies, which generates relative value units (the almighty RVUs) for radiologists. While this trend is something to be mindful of, at least we know for sure that interventional radiologist salary levels will not be affected! The effect will be marginal for modalities that require patient-radiologist interaction like ultrasound studies or mammography, but it remains to be seen how the trend will affect general / plain film radiologists.

Friday, January 21, 2011

Radiology's Growing Role In Psychiatry

A recent piece in the journal Nature details the role for imaging in psychiatry, specifically the development of near infrared spectroscopy (NIRS) for the diagnosis of mental health disorders, in particular bipolar disorder, in Japan:
Last year, doctors in Japan started using a relatively new technique — near-infrared spectroscopy (NIRS) — to distinguish between schizophrenia, depression, bipolar disorder and normal mental-health states (see page 148). It is not difficult to see why this was a popular move. Doctors like it because it is easy to use. Patients like its objective nature, and that it provides them with physiological evidence of a disorder. And officials at the health ministry are happy because it represents a public success of their drive to innovate.

In Japan, NIRS diagnosis is one of dozens of advanced medical techniques offered to patients — at their own expense — despite not having gone through the clinical trials needed for approval by national health insurance. But is it ready for the clinic? Most scientists contacted by Nature do not think so. The patient groups of the supporting studies were small. The tests have not been reproduced in various clinical settings as one might hope. There is no international consensus on how best to measure NIRS parameters, much less a clear consensus on how to apply them to mental health. And if it is not ready, the same advantage that has patients lining up for it — the authority of an objective, physiological measure, the air of the incontrovertible — will become an obstacle. A misdiagnosis that carries the authority of an 'objective' measurement will probably be even more difficult to overturn.
Click here to read on about the difficulties of introducing any new diagnostic technique and validating it, both in terms of how to define appropriate application of a technique as well as who should foot the bill during the experimental phase of a technique. Still, the idea of using MRI or ultrasound techniques much like infrared is extremely promising given the lack of ionizing radiation involved. Patient safety groups may still raise various concerns, but certainly the main risk of oncogenesis is mitigated.

Regardless of the outcome of this particular technique, the field of "radiopsychiatry" or whatever you would like to call it is almost certain to boom over the next decade, especially as techniques become validated and scaled up for use in clinics around the world, leading to a boom not only in radiology but as well as in psychiatry. Ultimately, patients with mental health disorders will benefit the most as they get more objective and accurate data about the nature of their ailments.

Friday, January 14, 2011

Ultrasonographer / Ultrasound Radiologist Salary And Jobs

The entire economy is slowly recovering from the slump of 2008, but unemployment remains high. While medicine in general and radiology in particular is relatively insulated from macroeconomic trends, radiology residents just graduating and entering the private market may face an adverse situation as radiologists are less likely to invest in a new practice in a down economy. However, the impact of the economic situation varies by subspecialty and region as well. Ultrasonography differs from fields like IR or mammography in that the quality of the sonographer has a large impact in the nature of the practice.

According to the Bureau of Labor Statistics:

Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association's Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738. 
Self-employed physicians—those who own or are part owners of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement.

That's right - the median salary for physicians as a whole is $186,044. Wow - that's a large number for any profession. It gets even better: for specialists like radiologists, the median salary is a whopping $339,738! Of course, after 14 years of college, medical school, internship, residency, and fellowship, such levels of compensation are somewhat rational. Smaller states counterintuitively provide higher levels of compensation. While it is hard to find breakdown statistics by fellowship for ultrasound in particular, it is generally known that interventional radiology earns slightly more than diagnostic radiology. Per the Radiologic Society of North America (RSNA), using data from 2009:

Of the 30 specialties surveyed, interventional radiologists scored third highest and diagnostic radiologists earned the fifth highest salary for 2009. 
With a median salary of $454,205, diagnostic radiologists' compensation increased by 3.7 percent in 2009, while interventional radiologists reported a median salary of $478,000, which was unchanged from the year before.
Again, a staggering number: diagnostic radiologic salaries were $454,205 for 2009! Even if ultrasound radiologist salary levels were 10% below the average, a salary of $409,000 would still be in the top 10 of physician specialties and in the top 1% earners nationally. Per the BLS, the future looks bright:
Employment is expected to grow much faster than the average for all occupations. Job opportunities should be very good, particularly in rural and low-income areas.
Employment change. Employment of physicians and surgeons is projected to grow 22 percent from 2008 to 2018, much faster than the average for all occupations. Job growth will occur because of continued expansion of healthcare-related industries. The growing and aging population will drive overall growth in the demand for physician services, as consumers continue to demand high levels of care using the latest technologies, diagnostic tests, and therapies. Many medical schools are increasing their enrollments based on perceived new demand for physicians. 
Despite growing demand for physicians and surgeons, some factors will temper growth. For example, new technologies allow physicians to be more productive. This means physicians can diagnose and treat more patients in the same amount of time. The rising cost of healthcare can dramatically affect demand for physicians’ services. Physician assistants and nurse practitioners, who can perform many of the routine duties of physicians at a fraction of the cost, may be increasingly used. Furthermore, demand for physicians' services is highly sensitive to changes in healthcare reimbursement policies. If changes to health coverage result in higher out-of-pocket costs for consumers, they may demand fewer physician services. 
Job prospects. Opportunities for individuals interested in becoming physicians and surgeons are expected to be very good. In addition to job openings from employment growth, openings will result from the need to replace the relatively high number of physicians and surgeons expected to retire over the 2008-18 decade. 
Job prospects should be particularly good for physicians willing to practice in rural and low-income areas because these medically underserved areas typically have difficulty attracting these workers. Job prospects will also be especially good for physicians in specialties that afflict the rapidly growing elderly population. Examples of such specialties are cardiology and radiology because the risks for heart disease and cancer increase as people age.

If you are interested in radiology and ultrasound in particular, the future holds much promise for continued growth in ultrasound radiologist salary levels despite stagnation in the job market overall. Even if you are looking for training as an ultrasound technician at an ultrasound technician school, the salary trend will benefit you through the "trickle-down" effect. Here's to 2011!

Friday, January 7, 2011

Top Radiology Posts From 2010

Thank you for reading along during 2010. The year has been a bit slow, but we have plans for adding more great content to answer all your radiology questions, including in-depth pieces on radiology salaries including posts on sonographer salaries and musculoskeletal radiologist salaries. We also will have more posts about radiology schools and education programs. Hopefully you have learned something from the content provided here. Looking for more great stuff? Here are the top posts of 2010: