Biomedical subjects

Jonathan H Sunshine

Publications and source records attributed to Jonathan H Sunshine.

At least 19 recordsLinked to original sources

PubMed2006

A portrait of pediatric radiologists in the United States.

OBJECTIVE: In recognition of the importance of pediatric radiology and the apparent shortage of radiologists in the field, the purpose of this study was to provide an extensive and detailed portrait of pediatric radiologists, their professional activities, and the practices in which they work. MATERIALS AND METHODS: We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample survey that achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compare information about pediatric radiologists with that for other radiologists. RESULTS: Approximately 3% of radiologists, some 800-900 physicians, are pediatric radiologists. Depending on how pediatric radiologist is defined, two thirds to three quarters of them spend 70% or more of their clinical work time doing pediatric radiology. Unlike other radiologists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corresponding reduction in income) than desire an increase in workload. Pediatric radiologists who spend 70% or more of their clinical work time in their field are older than radiologists in general (average age, 55 vs 51 years), and the fraction of pediatric radiologists younger than 45 years is lower than for other subspecialists ( approximately 20% vs 37%). Pediatric radiologists are disproportionately women (one third or more, depending on definition, are women, vs 19% for other subspecialists and 15% for nonsubspecialists), hospital-based, in academic practices (approximately half vs one fifth for other subspecialists), and in the main cities of large metropolitan areas. CONCLUSION: A shortage of pediatric radiologists exists and is likely to intensify. Access to pediatric radiologists is probably a problem except for children in large metropolitan areas who connect readily to academic hospitals. Means to overcome these problems need to be actively sought.

Diagnostic Imaging↗

PubMed2006

Retirement patterns and plans of radiologists.

OBJECTIVE: The objectives of our study were to describe radiologists' recent retirement plans and patterns and to assess whether changes in radiologists' retirement patterns over the period of 1995-2003 explain the recent easing of the radiologist shortage. MATERIALS AND METHODS: We present detailed information from 2003 about the planned retirement age of radiologists, their labor force participation late in their careers, and their actual retirement pattern based on data from the American College of Radiology's (ACR) 2003 Survey of Radiologists. To analyze changes over time, we compare these data with information from the ACR's 1995 and 2000 Surveys of Radiologists. Multivariate regression analysis was also used to identify the effects of radiologist and practice characteristics on radiologists' retirement plans. RESULTS: The percentage of radiologists fully retired and the average retirement age were the same in 1995 and 2003. Overall, labor force participation rates were decreasing over the period 1995-2003 for both women and men. Standardized labor force participation rates for radiologists age 55-74 years appeared to decrease from 1995 to 2000 and remained at a lower level in 2003, but the changes were not statistically significant. As of 2003, radiologists retired at 64, approximately 2 years older than the average U.S. worker. CONCLUSION: Radiologists remain active in their profession longer than the typical U.S. worker. There was no change in radiologists' pattern of gradually moving into retirement. If anything, radiologists were retiring earlier in 2003 than in the past. A delay in retirement is not an explanation of the recent easing of the radiologist shortage.

Aged↗

PubMed2006

A portrait of breast imaging specialists and of the interpretation of mammography in the United States.

OBJECTIVE: Because of the importance of breast imaging as a radiology subspecialty and concerns about malpractice, the purpose of our study is to provide a detailed portrait of breast imaging specialists, their professional activities and practices, and information on all radiologists who interpret mammograms. MATERIALS AND METHODS: We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a large, stratified random sample survey that achieved a 63% response. Responses were weighted to make them representative of all radiologists in the United States. RESULTS: Approximately 10% of all radiologists, or 2,700-2,800 radiologists, are breast imaging specialists, but 61% of radiologists interpret mammograms, and only approximately 30% of mammograms are interpreted by breast imaging specialists. Of radiologists who reported that breast imaging was their primary specialty, only 21% took a fellowship in the field (much lower than for other subspecialties), 59% spent > or = 50% of their clinical work time in the specialty, 82% interpret > or = 2,000 mammograms annually, and only 11% (also well below other subspecialties) report that the main subspecialty society (the Society of Breast Imaging) is one of the two most important professional organizations for them. On average, breast imaging specialists, like other radiologists, report that their workload is about as heavy as desired. Their level of enjoyment of radiology does not differ significantly from average. CONCLUSION: Breast imaging appears not to be as strongly organized to raise awareness of and support for its problems as are other subspecialties. Although others find evidence of likely future problems, breast imaging specialists are not currently overworked or less satisfied in their profession than other radiologists, despite relatively low revenue generation and a particularly high risk of a malpractice lawsuit.

Biopsy, Fine-Needle↗

PubMed2006

Update on the diagnostic radiology employment market: findings through 2005.

OBJECTIVE: The purpose of this study is to analyze and summarize the latest data describing the diagnostic radiologist employment market. MATERIALS AND METHODS: Three sources of data--vacancies in academic radiology departments as of July 1, 2005; the ratio of job listings to job seekers at a major placement service; and the number of positions advertised in the American Journal of Roentgenology and Radiology-are presented and compared with previous data. RESULTS: Vacancies in academic departments averaged 4.5 in 2005, an increase of 16% from 2004 but a decrease of 16% from the 2001 peak. Vacancies increased from 2004 in all specialties except nuclear medicine and "other," and vacancies decreased from 2001 in all specialties except pediatric radiology and purely research positions. Job listings per job seeker increased 8% from 2004 but remain far below peak levels. The total number of positions advertised decreased by 6% from 2004, reaching the lowest level since 1998. In 2005, 42% of the total advertised jobs were academic, as compared with 45% in 2004. Proportional decreases were seen between 2004 and 2005 in total advertisements per region except the Northwest and California. The largest proportional increases in subspecialties occurred in general radiology, abdominal imaging, and "other." CONCLUSION: Data from the American College of Radiology Professional Bureau and a survey of academic radiology departments show an increased demand for diagnostic radiologists in 2005, whereas data from the help wanted index show a decrease. In addition, the regional distribution of advertisements and the proportion of advertisements for certain specialties have shown some shifting in 2005. We believe the job market remains strong, with regional and specialty shifting.

Advertising↗

PubMed2006

How could the radiologist shortage have eased?

OBJECTIVE: In 2000, a severe shortage of diagnostic radiologists existed in the United States. We seek to explain how the shortage eased greatly by 2003, despite the fact that the total imaging workload usually grows much faster than the number of radiologists in practice, which would be expected to intensify the shortage. MATERIALS AND METHODS: We measured the contribution of eight possible explanations, predominantly using simple quantitative analyses. We analyzed published data, data on the volume of imaging from Medicare and from the Medical Expenditure Panel Survey, data on residents and fellows from the American College of Radiology's (ACR) membership department, data on residents from the American Board of Radiology, data from the ACR's 1995 and 2003 Surveys of Radiologists, and data from interviews about nighthawk services. RESULTS: From these data sources, we determined the following. Total imaging and imaging by radiologists continued to grow rapidly--by > 20% from 2000 to 2003 (measured in relative value units), which was somewhat faster than in the years preceding 2000 when the shortage was building. Foreign imagers took on a negligible portion of the workload. No reductions in retirement occurred among radiologists during 2000-2003, a 10-20% decrease in the annual number of residency graduates occurred, and no increase in residents going directly into the workforce rather than taking a fellowship was noted. Radiologists' average annual work hours were relatively constant, increasing by perhaps 2%. Work done per hour--that is, productivity--increased sharply (by approximately 15%) during this period. CONCLUSION: Increased productivity is the predominant explanation of how the radiologist shortage eased. The contribution of other factors was, in comparison, small or even in the opposite direction.

Diagnostic Imaging↗

PubMed2005

Who's overworked and who's underworked among radiologists? An update on the radiologist shortage.

PURPOSE: To use weighted data and information on hours worked to investigate further the market for radiology services by analyzing the extent to which radiologists wanted less or more work in 2003. MATERIALS AND METHODS: Weighted data were used from the American College of Radiology's 2003 Survey of Radiologists. A statement on the survey cover sheet indicated that responses would not be individually identified, and responses were processed by an outside contractor for enhanced assurance of confidentiality. The authors analyzed workloads and the desired workload changes for radiologists who wanted less work, those who wanted more work, and those who sought no change in their workload. Multivariate regression analysis was also used to identify the probable causal links between characteristics of radiologists and the practices they work in and their desire for a workload change. RESULTS: The net average workload change sought was approximately 0.1% of the current workload and was not significantly different from zero, indicating that the overall total workload is what is desired. However, radiologists working in academic or government practices sought 4% and 12% more work, respectively, while those in private practices sought 2% less. In addition, radiologists working in nonmetropolitan practices sought 3% less work than those in large metropolitan areas. CONCLUSION: There was an overall balance between the demand and the supply of radiologists in 2003. The authors found some imbalances, including surpluses in academic and government-owned practices, a shortage of radiologists in private radiology groups, and a shortage in nonmetropolitan areas. There were differences in radiologists' desired workload by sex, age, and type and location of practice.

Humans↗

PubMed2005

Workload of radiologists in the United States in 2002-2003 and trends since 1991-1992.

PURPOSE: To measure the workload of radiologists in the United States in 2002-2003, variations in workload according to practice characteristics, and trends since 1991-1992. MATERIALS AND METHODS: Non-individually identified data from the American College of Radiology (ACR) 2003 Survey of Radiologists were compared with data from previous ACR surveys; all statistics were nationally representative. Workload according to individual practice characteristics, such as size, type, location, and setting, was tested for statistically significant differences from the overall average. Time trends and the independent effect on workload of practice characteristics were measured with regression analysis. Changes in average procedure complexity were calculated in physician work relative value units (RVUs) per Medicare procedure. RESULTS: In 2002-2003, the average workload per full-time equivalent (FTE) radiologist was 13,900 procedures annually (standard error of mean, 200), an increase of 8.1% since 1998-1999 (P < .05) and 25.1% since 1991-1992 (P < .01). Academic practices performed 9900 procedures per FTE radiologist, and private radiology practices performed 15,200 procedures per FTE radiologist. Within most practice categories, radiologists at the 75th percentile of workload typically performed at least 50% more procedures than radiologists at the 25th percentile. Average physician work RVUs per Medicare procedure increased by 6.2% between 1998 and 2002 and by 21.6% between 1992 and 2003, mainly because of an increase in the share of more complex techniques such as magnetic resonance imaging and computed tomography in the procedure mix. CONCLUSION: Workload per radiologist measured in procedures and RVUs increased steadily between 1991-1992 and 2002-2003. Because there is much unexplained variation, averages or medians should not be used as norms.

Data Interpretation, Statistical↗

PubMed2005

Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations.

PURPOSE: To assess the most recent available data for levels and trends in utilization of radiology procedures across populations, modalities, and geographic areas. MATERIALS AND METHODS: Aggregated claims data from Medicare enrollees for all radiology procedures and from the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of almost 25 000 Americans, for some radiology procedures, were used to calculate population-based utilization for the relevant age groups. Limited private insurer data also were obtained. All radiology utilization was measured and reported, irrespective of provider specialty. Average levels and percentiles of utilization were measured according to modality, and average annual rates of increase in utilization were compared across modalities, data sources, and regions. Rates of increase in utilization according to modality and state were compared for correlation with state characteristics and initial utilization levels. RESULTS: In 2001, 4176 diagnostic and 274 therapeutic radiology procedures were performed per 1000 Medicare non-managed care enrollees. Nearly one-half of diagnostic procedures (n=2057) involved radiography. The other half involved computed tomography (CT) (n=391), magnetic resonance (MR) imaging (n=114), ultrasonography (US) (n=921), interventional radiology (n=215), mammography (n=221), and nuclear medicine (n=249). On average, between 1998 and 2001, utilization per Medicare enrollee increased 16% per year for MR imaging and 7%-15% per year for CT, US, interventional radiology, and nuclear medicine, while that for radiography increased 1% per year. The proportion of diagnostic radiology procedures performed in ambulatory settings increased from 62% in 1992 to 68% in 2001. There was wide variation across states in utilization by Medicare enrollees. State totals for diagnostic radiology were 3038 in the 10th percentile and 4573 in the 90th percentile. In 1999, MEPS reported average utilization in ambulatory settings as follows: 64 MR imaging, 102 US, 73 mammographic, 326 radiographic, and 43 radiation therapy procedures per 1000 persons (all ages) in the U.S. population. CONCLUSION: Utilization of high-technology modalities increased rapidly, while that of radiography was relatively stagnant. Variation in utilization among states and census regions was substantial.

Data Interpretation, Statistical↗

PubMed2005

Relative procedure intensity with self-referral and radiologist referral: extremity radiography.

PURPOSE: To compare the relative use of bilateral versus unilateral extremity radiographic examinations when patients are referred to radiologists for imaging (radiologist referred) versus when studies are performed in the referring physician's office (self-referred). MATERIALS AND METHODS: We reviewed 1 year of claims data for extremity radiographic examinations performed by a referring physician or referred to a radiology facility and claims data for related patient office visits. Data were analyzed for orthopedics, podiatry, and rheumatology, and data were divided by the practice pattern of the referring physician into pure self-referring, pure radiologist-referring, and mixed-referring categories. We compared the percentage of unilateral and bilateral studies and the number of unilateral and bilateral studies per 100 office visits in each setting. Statistical analysis of each comparison was performed with a one-tailed Z test. RESULTS: A total of 13 094 (14%) self-referred studies were bilateral, while 778 (10%) radiologist-referred studies were bilateral (P < .001). The rate of self-referred bilateral examinations was 2.21 times higher per 100 office visits than the rate of radiologist-referred bilateral examinations. Combined bilateral and unilateral use by self-referrers was only 1.86 times higher than use by radiologist-referrers. Orthopedists had no clinically meaningful difference in the percentage of self-referred and radiologist-referred bilateral studies, but they ordered 1.98 times as many studies per 100 visits when they self-referred studies. Self-referring podiatrists and rheumatologists ordered bilateral studies up to 3.25 times more frequently than did their radiologist-referring colleagues. Mixed-referring podiatrists had 2.70-times increased use of bilateral examinations when performing imaging in their offices, whereas mixed-referring rheumatologists had 6.40-times increase in that setting. CONCLUSION: Orthopedists, podiatrists, and rheumatologists use extremity radiography at a higher rate when they self-refer. Moreover, self-referring podiatrists and rheumatologists order radiographic examinations of increased intensity compared with radiologist-referring physicians.

Humans↗

PubMed2005

A portrait of interventional radiologists in the United States.

OBJECTIVE: In recognition of the emergence of interventional radiology as an important "new component of...radiology," the objective of our study was to provide an extensive and detailed portrait of interventional radiologists, their professional activities, and the practices in which they work. MATERIALS AND METHODS: We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that oversampled interventionalists and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compared information about interventionalists with that for other radiologists. RESULTS: Depending on the definition of who is an interventionalist, 8.5-11.5% of radiologists are interventionalists. By most definitions, only slightly under half of interventionalists spend 70% or more of their clinical work time performing interventional procedures. Interventionalists work, on average, 56-58 hr weekly, a few hours longer than other radiologists. The average interventionalist performs procedures in five of the seven categories of procedures into which we divided interventional radiology, compared with one or two categories for other radiologists. The average interventionalist performs procedures in five of the seven broad categories (such as MRI, CT, and nuclear medicine) into which we divided all of radiology, much the same breadth of practice as other subspecialists and also as nonsubspecialists. CONCLUSION: Interventionalists have become a sizable group within radiology. They are in some ways like other radiologists and in other ways different, but they do not spend as much of their time in their subspecialty as some assume and, overall, are not as different.

Humans↗

PubMed2005

Update on the diagnostic radiologist employment market: findings through 2004.

OBJECTIVE: The objective of this article is to summarize the latest information concerning the diagnostic radiologist employment market. MATERIALS AND METHODS: Three sources of data are presented and compared with previous data: vacancies in academic radiology departments as of July; the ratio of job listings to job seekers at a major placement service; and the number of positions advertised in Radiology and the American Journal of Roentgenology. RESULTS: Vacancies in academic radiology departments averaged 3.9 in 2004, down 29%, and decreased for all subspecialties as compared with 2001, but the number of vacancies remained very similar to that for 2003. Job listings per job seeker were 1.1 in 2004, stable over the past 2 years but at the lowest level since 1997. The overall number of positions advertised declined by 14% in 2003 compared with 2002 and by an additional 17% in 2004, reaching the lowest level since 1998. In 2004, 45.3% of positions advertised were academic. Comparing 2003-2004 with 2001-2002, all geographic regions exhibited absolute declines in advertisements except the Northeast, which showed a 1.5% increase. Absolute increases occurred for musculoskeletal and emergency radiology positions. Statistically significant proportional decreases occurred for general radiology, vascular/interventional radiology, and pediatric radiology. CONCLUSION: Three separate data sources confirm a substantial and broad-based multiyear decline in the strength of the demand for diagnostic radiologists, with some shifting in relative demand for subspecialties. It is not clear if the decrease continued in 2004 or if 2004 demand was similar to that of 2003. Data are relative and do not indicate the employment market is weak in absolute terms.

Advertising↗

PubMed2005

A comprehensive portrait of teleradiology in radiology practices: results from the American College of Radiology's 1999 Survey.

OBJECTIVE: This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared. MATERIALS AND METHODS: In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses. RESULTS: Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs. CONCLUSION: Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.

Diagnostic Imaging↗

PubMed2004

Self-referred whole-body imaging: where are we now?

PURPOSE: To identify current patterns and trends of computed tomographic (CT) screening, including geographic data, services provided, facility type, and demographic characteristics. MATERIALS AND METHODS: In March 2003, self-referred body imaging (SRBI) centers were identified by using the Internet. Data involving geographic location, type of facility, services provided, and demographic characteristics were collected. The 2000 U.S. census data were used to compare center locality demographics with national patterns. Descriptive statistics, t tests, and regression analyses were used to evaluate data. Nonstatistical comparisons were made with results obtained from a previously published analysis. RESULTS: The number of SRBI centers totaled 161 (vs 88 in a comparative study in 2001), and centers were distributed across 31 states and Washington, DC (vs 21 in 2001). Racial demographics of center localities more closely resembled national averages in the current study, with equal percentages of whites (76.0% vs 77.1% nationally) and Hispanics (11.5% vs 12.5% nationally). Center localities continued to exhibit greater wealth and levels of education, as reflected by higher income per capita and median household income (P < .05), as well as by higher percentages of people with college and advanced degrees (P < .05). Heart scanning was the most commonly offered service (n = 152, 94%), followed by whole-body scanning (n = 135, 84%), lung scanning (n = 126, 78%), and virtual colonoscopy (n = 88, 55%). Centers in the West were more likely to offer whole-body and organ-specific scanning, compared with centers in other regions (P < .001 for virtual colonoscopy, P < .05 for head scanning). Hospital-based centers were less likely to offer services other than heart scanning (P < .001). CONCLUSION: Compared with results of a prior analysis, SRBI centers have increased and are distributed more widely in areas with a population that more closely resembles national norms. The increased trend to broaden services may suggest possible saturation of the preexisting market.

Colonography, Computed Tomographic↗

PubMed2004

Emergency department image interpretation services at private community hospitals.

PURPOSE: To investigate the methods used at private community hospitals for delivering emergency department (ED) image interpretation services. MATERIALS AND METHODS: The authors contacted a random national sample of 114 hospitals by telephone and administered an "ED Radiology Coverage" questionnaire. The questionnaire included queries about daytime image interpretation duties, nighttime radiology coverage arrangements, and radiologist staffing needs. Results were stratified on the basis of ED patient volumes and trauma center designation and were analyzed statistically by using multivariate and logistic regression analyses. RESULTS: Representatives of 97 EDs responded to the questionnaire. Community hospital radiologists performed daytime primary interpretation of radiographs at 39 (40%) of 97 EDs, computed tomographic (CT) scans at 91 (95%) of 96 EDs, and ultrasonographic images at 87.5 (93%) of 94 EDs. "ED-dedicated" radiologists performed this emergency radiology work in only two (2%) of 97 EDs. During the nighttime, eight (8%) of 97 EDs had no radiology coverage, 80 (82%) of 97 EDs used teleradiology services in some form, and nine (9%) of 97 EDs employed in-house, rotating "non-ED-dedicated" radiologists. Analysis of participant responses revealed that clinicians at 37 (38%) of 97 EDs were able to consult radiologists for nighttime radiography questions, and 87 (92%) of 95 EDs had nighttime CT scans read by radiologists in time for patient care decisions. Twenty-four (25%) of 97 EDs reported radiologist staffing shortages, but only one indicated that it was actively trying to recruit ED-dedicated radiologists. Results of logistic regression analysis indicated that higher ED patient volumes (P =.005) and the presence of a trauma center (P =.02) each significantly increases the probability of higher nighttime levels of radiologist coverage. CONCLUSION: There is great variation in the current provision of emergency radiology services in private community hospitals.

Academic Medical Centers↗

PubMed2004

Technology assessment for radiologists.

Health technology assessment is the systematic and quantitative evaluation of the safety, efficacy, and cost of health care interventions. This article outlines aspects of technology assessment of diagnostic imaging. First, it presents a conceptual framework of a hierarchy of levels of efficacy that should guide thinking about imaging test evaluation. In particular, the framework shows how the question answered by most evaluations of imaging tests, "How well does this test distinguish disease from the nondiseased state?" relates to the fundamental questions for all health technology assessment, "How much does this intervention improve the health of people?" and "What is the cost of that improvement?" Second, it describes decision analysis and cost-effectiveness analysis, which are quantitative modeling techniques usually used to answer the two core questions for imaging. Third, it outlines design and operational considerations that are vital if researchers who are conducting an experimental study are to make a quality contribution to technology assessment, either directly through their findings or as an input into decision analyses. Finally, it includes a separate discussion of screening--that is, the application of diagnostic tests to nonsymptomatic populations--because the requirements for good screening tests are different from those for diagnostic tests of symptomatic patients and because the appropriate evaluation methods also differ.

Cost-Benefit Analysis↗

PubMed2004

Financial ratios in diagnostic radiology practices: variability and trends.

PURPOSE: To evaluate variation in financial ratios for radiology practices nationwide and trends in these ratios and in payments. MATERIALS AND METHODS: In 1999, the American College of Radiology surveyed radiology practices by mail. The final response rate was 66%. Weighting was used to make responses representative of all radiology practices in the United States. Self-reported financial ratios (payments, charges, accounts receivable turnover) were analyzed; 449 responses had usable data on these ratios. Comparison with results of a similar 1992 survey and combined analysis with Medicare data on billed charges provided information on trends. RESULTS: All measures of payment collections declined sharply from 1992 to 1999, with the gross collections rate (revenues as percentage of billed charges) decreasing from 71% to 55%. Average payment for a typical radiology service decreased approximately 4% in dollar terms or approximately 19% in inflation-adjusted terms. In 1999, nonmetropolitan practices appeared to fare better than others. Among insurers, Medicaid stood out as a low and slow payer, but neither managed care nor Medicare had a consistent effect on financial ratios. The gross collections rate varied substantially across geographic areas, as did, in an inverse pattern, the level of billed charges. One-quarter of practices had accounts receivable equal to 90 or more days of billings. CONCLUSION: The opposing geographic pattern of billed charges and gross collection rate suggests that geographic variation in the latter is driven more by variation in billed charges than by variation in payment levels. Radiologists saw a substantial decrease in the real (inflation-adjusted) value of payment per service during the 1990s. The large fraction of practices with accounts receivable of 90 or more days of billings-a level considered potentially imprudent by financial management advisors-suggests that many practices should improve financial management and that state prompt-payment laws have not had a substantial positive effect.

Data Collection↗

PubMed2004

The relationship of managed care to business, professional, and organizational aspects of radiology practices.

OBJECTIVE: We sought to determine the extent of managed care involvement among radiology practices of different types, locations, and sizes; the factors associated with differences in involvement; and the impact of managed care on professional, organizational, financial, and hospital-relations aspects of radiology practices. MATERIALS AND METHODS: A survey was mailed in 1999 to a sample of 970 radiology practices; completed, usable surveys were returned by 66% of the practices. Three indicators of managed care were used: a practice's percentage of managed care (HMOs plus preferred provider organizations), local area HMO penetration rate, and self-reported perceived effect of managed care. RESULTS: Percentage of managed care averaged 30% but was 40% for multispecialty groups. It was relatively high in large metropolitan areas, for practices with no hospital activity, and for practices with any owners who were not practice members. The three measures of managed care were only moderately correlated (correlation coefficient, 0.25-0.33). None of the managed care variables had a statistically significant effect on days provided for vacation and continuing medical education, promptness of payment, years required for practice ownership (partnership), and percentage of practice members who were owners. Higher percentage of managed care was associated with higher collection rates, whereas greater perceived impact of managed care had the opposite association. Two thirds of practices belonged to at least one managed care-related organization such as an independent practice association. Most radiology practices reported no involvement in the managed care negotiations of hospitals, which was true even when the hospital's negotiations included the radiologists' fees or when the practice determined its level of involvement. CONCLUSION: Many negative outcomes most feared by radiologists regarding the effect of managed care have not materialized. Perceptions of practices as to the effect of managed care seem to reflect negative aspects of their general situation, not only realities of managed care.

Attitude of Health Personnel↗

PubMed2004

Update on the diagnostic radiologist shortage.

OBJECTIVE: The purpose of this study is to present the latest information available on the shortage of diagnostic radiologists. MATERIALS AND METHODS: Four sources of information are available, and we present their data: first, the number of jobs for diagnostic radiologists advertised in Radiology and the American Journal of Roentgenology; second, vacancies in academic radiology departments as of July 1, 2003, ascertained by a survey of these departments; third, the ratio of job listings to job seekers at a major professional placement service, the Professional Bureau of the American College of Radiology (ACR); and fourth, diagnostic radiologists' self-reported workload burden, from the ACR's 2003 Survey of Diagnostic Radiologists. RESULTS: Jobs advertised in September-November 2003 (latest data available) were 28% fewer than in the same months of 2002. Vacancies per department averaged 3.9 in 2003, compared with 5.4 in 2001 and 5.1 in 2002. Listings per seeker were 1.4 in 2002 (latest data available) compared with 3.0 or more in 1999 and 2000. Responses to a question directly tying changes in workload to changes in income indicated that reported desires for workload reduction and workload increase were approximately equal. CONCLUSION: All four information sources have important limitations, but all indicate that the shortage has considerably eased. We plan to study the causes of this easing and continue to monitor the situation.

Academic Medical Centers↗