Career CoNNection

News & Updates
The latest industry developments and current articles from RSNA News.

Medicine Not "Bulletproof" in Recession
	While radiology demand, particularly in acute care medicine, remains steady, physicians are taking precautions to protect themselves from the effects of the U.S. economic downturn. "I don't think medicine can be seen as bulletproof to a recession," said Bibb Allen, M.D., chair of the American College of Radiology Commission on Economics. "Like a lot of other businesses, healthcare is not totally a cash operation," he said. "Hospitals and larger businesses have seen their investments suffer because of the falling stock market and falling interest rates. The availability of money for capital purchases, the amount of dividend income that foundations are contributing to their operations, all of those things are bad." As one of the fastest growing areas of healthcare spending, imaging services previously seemed immune to economic ebb and flow. Between 2000 and 2006, federal payments for imaging doubled, from $7 billion to $14 billion. That annual growth rate of nearly 13 percent was outpaced by growth in advanced imaging procedures, such as MR imaging and CT, which expanded at an annual rate of 17 percent, according to figures from the Congressional Budget Office. Following the Deficit Reduction Act (DRA) of 2005, the increase in spending on physician imaging services reversed and Medicare expenditures on imaging exams fell to $12.1 billion in 2007, a decline of almost 13 percent from 2006. With the freefall in the U.S. stock market and the increase in unemployment, it's not just consumer confidence that is in short supply, said radiologists. "I didn't talk to anybody at last year's RSNA meeting who wasn't commenting about cutbacks in capital spending," said James H. Thrall, M.D., a professor of radiology at Harvard Medical School and radiologist-in-chief at Massachusetts General Hospital. "There were many people who said their hospital simply had no capital program for this year. "With the turmoil in the financial markets, it's much harder for hospitals to raise money through the sale of bonds," Dr. Thrall continued. "Therefore it's going to be harder for them to buy capital equipment. I think that our vendor community is going to be hit pretty hard. We may lose some vendors who are on the margin."
Treadmill Workstations Get Radiologists Moving
	RADIOLOGISTS can add simultaneous physical exercise on a treadmill to their daily image reading routines without compromising diagnostic accuracy, according to an exhibit presented at RSNA 2008. “Radiologists have a relatively sedentary workday in comparison to other healthcare workers and especially in comparison to other workers in general,” said Amee Patel, M.D., a resident at the University of Maryland Hospital and Baltimore VA Medical Center, who presented “Walking While Working: A Demonstration of a Treadmill-based Radiologist Workstation.” “Radiologists can increase their energy expenditure by a factor of more than 2.5 by walking on a treadmill for a portion of their day, even at only 1 mile per hour,” said Dr. Patel. Dr. Patel and colleagues tested a combined treadmill and workstation, called a walkstation, in a pilot involving detection of lung nodules on conventional chest radiographs. Performance was measured with radiologists sitting, standing and walking. The concept of adding physical activity to sedentary work is not new— combined work/exercise equipment is gaining popularity in healthcare and other professions with offerings from a number of manufacturers. Dr. Patel said her study addresses concerns about distraction and loss of accuracy for radiologists. “I think these are valid concerns,” she said. “That is the precise reason studies should be done to provide scientific data showing how performance while on the walkstation varies from the traditional reading room where the radiologist sits in front of a workstation. This was our goal when we conducted our pilot earlier this year.” No Significant Difference in Accuracy Seen Results showed sensitivity and specificity, respectively, of 71 percent and 77 percent for sitting, 76 percent and 69 percent for standing, and 80 percent and 56 percent for walking. “Our study showed no significant change in the accuracy in the detection of lung nodules on chest radiographs among three image interpretation modes,” Dr. Patel said, noting that there was also no evidence of memory effect. “Not only have we found that radiologists can use a walkstation while interpreting diagnostic imaging studies, but we were unable to find any decrease in diagnostic accuracy,” she said. Regarding the increase in sensitivity—but decrease in specificity— from sitting to walking, Eliot L. Siegel, M.D., offered a theory. “A very well-known radiologist, the late Dr. Ben Felson, wrote in his famous ‘red book’ about a ‘cowboys and Indians’ phenomenon, in which the Indians were able to see better because, in fact, their heads were bobbing up and down, either on the run or on a horse,” said Dr. Siegel, a professor of diagnostic radiology and nuclear medicine at the University of Maryland Medical Center and a member of the RSNA Radiology Informatics Committee. “Perhaps the same factors are at play with the walkstation. I haven’t even talked to Amee about this yet, but I’d love to do a phantom study with different objects of different sizes and test the effects of movement on visualization.” Responses to the walkstation have been varied, said Dr. Patel. “Some people liked the prospect of increasing activity levels while doing their work because they were naturally active individuals,” she said. “Others found the apparatus distracting and preferred to sit
Radiologists Seek Ways to Measure and Improve Productivity
	More than half of radiologists in private practice, along with a majority of those in academia, now find themselves compelled to measure their productivity, according to presenters of an RSNA 2008 session. When conducted thoughtfully, measurement can have a positive impact on employee morale as well as performance, said Richard Duszak Jr., M.D., a diagnostic and interventional radiologist in practice in Memphis, Tenn. Less productive physicians work harder and respond more willingly to non-clinical demands, he said, while productive physicians feel more comfortable in the work environment. "Proper management now requires that we get more bang for the buck," said Stephen Chan, M.D., who along with Richard Duszak Jr., M.D., presented "Tracking Radiologist Productivity: Is It Necessary and How Should It Be Done?" Dr. Chan, an academic radiologist at New York's Columbia University, said measurement is absolutely necessary for increased productivity in the academic setting, as competition for imaging dollars increases and fewer dollars exist to pay radiologists and support research and education. In the clinical setting, productivity measurement is imperfect but still useful, said Dr. Duszak, a diagnostic and interventional radiologist in practice in Memphis, Tenn. All too often, "groups don't go down this pathway because of pure academic, intellectual and business reasons, but instead want to validate their subjective, emotional or political reasons," said Dr. Duszak. Practices that do see a need to measure productivity, he said, should address desired behavior: administrative work, practice and relationship development and support of those motivated physicians he called "good sandbox players." Drs. Chan and Duszak cautioned that ill-considered productivity measurement may not reflect reality and may harm conscientious workers, lead to cherry-picking of responsibilities and damage morale. When conducted thoughtfully, measurement can have a positive impact on morale as well as performance, they said. When measurement begins, discontent often abates, said Dr. Duszak. Less productive physicians work harder and respond more willingly to non-clinical demands, while productive physicians feel more comfortable in the environment. Radiology practices measuring productivity often reward or penalize individual or group performance outcomes with monetary bonuses or fines or by offering or withholding vacation time, said Dr. Duszak. "Pride, money, embarrassment and vacation are strong motivators," he said. Stephen Chan, M.D. Clinical practices are measuring productivity by examinations read, by revenue or by relative value units (RVUs), the CPT code-based measurement of physician services that provides benchmarks for evaluating productivity in clinical radiology. So as not to penalize those also responsible for critical but non-clinical services, practices may separate non-quantifiable responsibilities and measure a physician's clinical work as a percentage of full-time employee status. In academic radiology, measurement involves a more complex effort, said Dr. Chan, tabulating clinical performance, numbers of peer-reviewed publications, time devoted to administration and community service, research grants and grant dollars and educational evaluations. The RVU system has no relevance outside of clinical medicine, said Dr. Chan, so practices develop their own ways to quantify non-clinical work. Dr. Duszak cited a useful "academic RVU" template created by Reuben Mezrich, M.D., and Paul Nagy, Ph.D., of the University of Maryland School of Medicine. The template, for evaluating work performed in research, education and administration, was published in the July 2007 issue of the Journal of the American College of Radiology. Meanwhile the very measurement of productivity has been found to increase work output, even when results are never communicated, presenters said. This so-called "Hawthorne Effect," asserts that perceived attention provides a short-term incentive such as that observed by researchers at Western Electric's Chicago-area Hawthorne Works in the 1920s.
Salary Survey Results Questioned
	AN ANNUAL salary study shows a continued trend in modest rises in compensation for most medical specialties, with concurrent losses for medical practices, and has drawn calls for changes to the ways physicians are compensated. The American Medical Group Association recently issued the 2008 Medical Group Compensation and Financial Survey, a 2008 report based on 2007 data. The survey, in its 21st year, is conducted by RSM McGladrey, Inc.’s Health Care Consulting Group. For radiologists, the AMGA Survey does not represent an applicable sample, said John A. Patti, M.D., a radiologist at North Shore Medical Center in Salem, Mass., and the group’s chief financial officer for the past 23 years. Dr. Patti also serves as vice-chair of the American College of Radiology (ACR) Board of Chancellors.
More Consultant Radiologists Needed To Meet Rising Demand, Say Doctors' Leaders, UK
	Main Category: Radiology / Nuclear Medicine Also Included In: MRI / PET / Ultrasound Article Date: 19 May 2008 - 1:00 PDT Around 1300 extra consultant radiologists are needed in England over the coming years if the NHS is to meet the increasing demand for emergency interventional treatments, diagnostic imaging and screening, the BMA warns. Recent Department of Health projections on workforce1 show there is a need for a focused and planned expansion in consultant numbers to meet the increasing demand for radiological services. Although government figures2 on diagnostic waiting times published yesterday show improvements in waiting, this level of activity cannot be sustained with the current workforce levels. The demand for ultrasound, CT and MRI scans is increasing year on year, and with complex imaging now being required around the clock, more consultants are needed to ensure the service can be delivered more quickly and at the highest standard. The Healthcare Commission's report on its investigation into maternal deaths at Northwick Park Hospital3 recognised that there was a shortage of suitably trained interventional radiologists and recommended all obstetric units should have urgent access to this crucial emergency treatment at all times. The Royal College of Radiologists (RCR) supports the need for consultant expansion. Dr Gill Markham, Vice-President of the RCR and Dean of the Faculty for Clinical Radiology, said: 'Demand for scans and complex imaging is rising year on year and is set to increase even further in light of recent developments with extra patients being referred from the Government's planned extension of the Breast programme and Colonic screening programme4. We need a steady and sustained expansion in consultant numbers if we are to deliver this level of service to patients safely and to the high standards that patients deserve." The BMA recently launched a campaign5 to enhance the quality of care for patients by expanding consultant numbers across many specialities. Dr Jonathan Fielden, chairman of the BMA's consultants committee said: "Although waiting times for diagnostics seem to be improving; this progress cannot be sustained unless capacity is expanded to meet future rises in demand. Ad-hoc commissioning of poorly integrated private providers is not a long term solution. The NHS needs to build its own sustainable infrastructure to deliver for the longer term benefit of patients. "Focused expansion of consultant numbers will not only help meet the extra demands on the NHS, but as medical leaders and innovators, this will enhance the development of local services and provision of teaching and research."
R.T. Wages Continue to Increase, but at Slower Rate, ASRT Survey Shows
	ALBUQUERQUE, N.M., July 26 /PRNewswire-USNewswire/ -- Results from a survey of nearly 10,000 radiologic technologists showed their average annual compensation is $58,673, an increase of 12.8 percent over 2004's average of $52,001. This compares to the 19 percent increase in average annual compensation from 2001 to 2004. These findings are from the 2007 Wage and Salary Survey report conducted by the American Society of Radiologic Technologists. "While compensation continues to increase," said ASRT's Director of Research, Richard Harris, Ph.D., "the rate of increase has slowed down. This is probably due to the closing of the gap from the shortage of radiologic technologists we experienced a few years ago. The data from this survey coincides with the information we have from the staffing surveys that ASRT has conducted."
Survey Finds Lifestyle Choices Are Driving Nighthawk Radiology
	Radiologists' desire to sleep at night and avoid call is more likely to drive demand for after-hours teleradiology services than is a need for extra personnel, according to a small survey of imaging department heads presented at the American Roentgen Ray Society meeting on Tuesday. The survey, conducted at Yale University School of Medicine, was distributed to 300 randomly selected hospitals. Of those contacted, 115 responded to the 59-question poll, which asked about utilization and rationales for using nighthawk-type services. Of the respondents, 63 (54%) reported using some degree of after-hours outsourcing.