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Letters to the Editor |
MDX Oncology, 1100 Bank Tower, Fourth Avenue at Wood Street, Pittsburgh, PA 15222
Editor:
Dr Sunshine and colleagues concluded in their recent article (1) in the July 1998 issue of Radiology that "contrary to concerns about a possible surplus of radiologists, the workload per radiologist has increased substantially in the past few years."
An equally if not more plausible conclusion in the face of the declining amount of reimbursement per procedure due to managed care would be that radiologists are electing to work harder (ie, interpret more images) to maintain income and hence raise the threshold for new-hire decisions. This would, of course, have negative implications for new entrants to a still growing workforce.
References
Department of Research, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191
Knowing some of Dr Straub's distinguished work on operational aspects of radiology practice (1), we are gratified by his interest in our article (2). The concern he raises is an important one that has worried many thoughtful persons in the profession, so we are pleased to have the opportunity to address it more explicitly than in our article, which answered it only implicitly.
If a great majority of radiologists have increased their average workload by more than 10%, as we find, and have done so by taking work from other radiologists, as Dr Straub fears may have happened, then either (a) about 10% of radiologists must be unemployed or (b) there must be a minority of radiologists—the losers in the workload transfer—whose work has greatly decreased. With regard to the former possibility, our study findings show that the unemployment rate of new graduates each year decreases to well below 1% by 6 months after they complete training (3–5), and the results of our 1995 survey of established radiologists (6) also indicated an unemployment rate well below 1%. As for the latter possibility, our data are an average for all radiologists in groups, and if some radiologists increased their workload at the expense of others, this average would remain unchanged. (The same total workload would be divided among the same total number of radiologists.) Thus, our finding that the average workload has increased substantially is not consistent with the thesis that the average rose because some radiologists increased their workload at the expense of others.
In short, our data show that the total workload of radiologists has increased substantially, and there is not a substantial problem of literal unemployment. (Whether graduates are obtaining jobs that are as attractive as they would like is another question, one on which we are pleased to have published extensive information [4,7]). Our finding about total workload is consistent with the conclusion of thoughtful observers of managed care: Managed care, at least to date, mostly has reduced the amount of care conducted in the hospital inpatient setting and has reduced payments to physicians, hospitals, and other providers but otherwise has relatively little affected which care services are actually provided to patients.
We conclude that during the first half of the 1990s in the United States, radiology continued its pattern of being a field in which technologic advances led to relatively rapid increases in the number of services performed per patient.
To be complete, two limitations of our data should be noted. First, we have no information on radiologists in solo practice, but we believe this does not change the overall conclusion because they are only 8% of all members of the profession (8). Second, we have not directly surveyed established radiologists since 1995. However, neither impressions nor more recent data (9,10) on the number of radiologists who left groups (voluntarily or involuntarily) for reasons other than retirement are consistent with an unemployment rate anywhere near 10%.
We do not want to seem dismissive of the effects of managed care. Managed care has left radiologists working harder (ie, interpreting more images) while earning less (11) and has greatly increased the hassle factor. That is a very substantial indictment. In contrast, however, so far the effect of managed care on the services that radiologists' patients actually receive has been much less.
References
This article has been cited by other articles:
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  L. Berlin Liability of Interpreting Too Many Radiographs Am. J. Roentgenol., July 1, 2000; 175(1): 17 - 22. [Full Text] [PDF]
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