Rads Pay

[NeuroD]

1 hour ago, Let'sGo1990 said:

Is there a report you can refer me to?

Don't know if there's any documents out yet. This is from the neurology OMA section call  few nights ago.

[anonymouspls]

With radiology there is such a high volume, and also high risk in terms of career choice because who knows what's going to be happening to radiology 10-15 years from now... I think they should be having increased compensation seeing as how they're hyper critical to the hospital and IIRC last year radiology had only 79 applicants for 78 spots despite the supposed high salaries.

[Raptors905]

1 hour ago, anonymouspls said:

With radiology there is such a high volume, and also high risk in terms of career choice because who knows what's going to be happening to radiology 10-15 years from now... I think they should be having increased compensation seeing as how they're hyper critical to the hospital and IIRC last year radiology had only 79 applicants for 78 spots despite the supposed high salaries.

I am not sure the competitiveness is a factor in salary. 
 

They are paid well. No one is diminishing their work. They provide an important service. So do lots of other specialities that are paid less and have to do call without benefit of real time radiology. Getting 1 million with 12 weeks off a year and no call beyond 9pm is a great deal 

[NeuroD]

10 hours ago, Raptors905 said:

I am not sure the competitiveness is a factor in salary. 
 

They are paid well. No one is diminishing their work. They provide an important service. So do lots of other specialities that are paid less and have to do call without benefit of real time radiology. Getting 1 million with 12 weeks off a year and no call beyond 9pm is a great deal 

Yeah and I'd also say that that logic should be applied to the services that make management decisions (some times split second ones like in stroke) based on their own reading of scans, independent from the rads read that may show up hours to days later.

[rmorelan]

4 hours ago, PhD2MD said:

Yeah and I'd also say that that logic should be applied to the services that make management decisions (some times split second ones like in stroke) based on their own reading of scans, independent from the rads read that may show up hours to days later.

although a stroke study should never be read "hours later" ha - let alone days. That is flat our improper care. 

I am part of the "new generation" of radiology, and things are changing. Fields get stuck in their history in a sense and radiology definitely did - there are a ton of staff that are currently working that predate the technology that allows anyone to read a study fast (20 years ago is not that long ago in medical terms ha). No PACS, no electronic reports, reports were mailed out or at best faxed - took days to get results. Nothing could happen fast ha. People went into the field with expectations as a result - no different than many other fields that also had to painfully adjust (I remember the major complaints when family medicine had to as their practise teams work evenings and weekends for the first time - many people went into that field because they didn't have to work evenings and weekends ha)

We don't live in that world now and radiology is changing - faster in the US than here but change regardless. It's a good thing too because old ways don't work, and hurt our patients. Radiology is becoming a 24/7 service - I for instance read the stroke studies at the scanner so as fast as they can possibly be read. That is a good thing because we are the best trained to read them (it is literally our jobs ha and we have the training to look at all possible pathology that may be present) and we have to step up to do that.  We just have to. If your centre cannot provide that level of service then nighthawk services are becoming more common to cover the difference (makes sense as small radiology teams cannot go 24/7 - you end up with teams of 4-5 radiologies doing worse call than junior residents forever - it destroys people - particularly as they get older, and already are getting reduced sleep with young families). 

 

 

[rmorelan]

15 hours ago, Raptors905 said:

I am not sure the competitiveness is a factor in salary. 
 

They are paid well. No one is diminishing their work. They provide an important service. So do lots of other specialities that are paid less and have to do call without benefit of real time radiology. Getting 1 million with 12 weeks off a year and no call beyond 9pm is a great deal 

I think it is the other way around - it is competitive because of the salary ha - and when something comes up that makes that look like it is going away there is a drop in applicants (threat of AI being really talked about, or cuts in fees etc). 

One factor in the salary unfortunately is the sheer volume - lots of fields work hard but haven't had the amount of work increase that much in the past say decade. Radiology objectively has had its work volume dramatically go up over the last 10 years forcing rads to read faster and faster, and longer and longer (we track the number of studies over time required). It really is just non stop - community rads particularly when new are just destroyed (6 day work weeks, 12 hours each is what they are telling us + call). Residency doesn't prepare you for the extreme volume basically and you need more time to learn to read fast. We are just flat out told to expect it to be much worse than residency in the beginning - the staff position is not the end of the rainbow for us ha. Eventually you can get the hang of it and it goes down but still it isn't the old days of relaxation ha. 

 

[rmorelan]

17 hours ago, anonymouspls said:

With radiology there is such a high volume, and also high risk in terms of career choice because who knows what's going to be happening to radiology 10-15 years from now... I think they should be having increased compensation seeing as how they're hyper critical to the hospital and IIRC last year radiology had only 79 applicants for 78 spots despite the supposed high salaries.

Truth is we never know - radiology constantly changes. Has for 50+ years to where if you take any point in time and compare to 15 years prior there are shocking differences. 15 years from now we are going to have very different imaging technologies (including possibly the death of the standard chest X Ray ha, imagine that - replaced with tomo). Multi-phasic CT, synthetic MRI, 3D ultrasound, contrast enhanced US, further merging with nucs for molecular imaging, interventional radiology just doing more and more....... We have CTs doing what MRI does, and MRI doing what CT can ha. AI is going to be in there somewhere. 

If you want to be on the cutting edge you have to accept you might get cut. Fun times

[NeuroD]

1 hour ago, rmorelan said:

although a stroke study should never be read "hours later" ha - let alone days. That is flat our improper care. 

I am part of the "new generation" of radiology, and things are changing. Fields get stuck in their history in a sense and radiology definitely did - there are a ton of staff that are currently working that predate the technology that allows anyone to read a study fast (20 years ago is not that long ago in medical terms ha). No PACS, no electronic reports, reports were mailed out or at best faxed - took days to get results. Nothing could happen fast ha. People went into the field with expectations as a result - no different than many other fields that also had to painfully adjust (I remember the major complaints when family medicine had to as their practise teams work evenings and weekends for the first time - many people went into that field because they didn't have to work evenings and weekends ha)

We don't live in that world now and radiology is changing - faster in the US than here but change regardless. It's a good thing too because old ways don't work, and hurt our patients. Radiology is becoming a 24/7 service - I for instance read the stroke studies at the scanner so as fast as they can possibly be read. That is a good thing because we are the best trained to read them (it is literally our jobs ha and we have the training to look at all possible pathology that may be present) and we have to step up to do that.  We just have to. If your centre cannot provide that level of service then nighthawk services are becoming more common to cover the difference (makes sense as small radiology teams cannot go 24/7 - you end up with teams of 4-5 radiologies doing worse call than junior residents forever - it destroys people - particularly as they get older, and already are getting reduced sleep with young families). 

 

 

I imagine that's at your fellowship center in the US? Was it the same when you did residency in Ottawa? At most of the places that I've done stroke rotations, neuro stands at the scanner and reads it live and decides on TPA before rads is in the room.

Of course Rads are the best trained in the field, but for the neuro example, unless its a subspecialized neuro rad they trust, neuro will usually just interpret it themselves. You see this with even more specialized fields (like the stroke example I gave, or the MS specialists who see one thing all day every day. Sure they'll miss a thyroid mass, but the MS management decisions often come down to the specialists read of the image).

[rmorelan]

1 hour ago, PhD2MD said:

I imagine that's at your fellowship center in the US? Was it the same when you did residency in Ottawa? At most of the places that I've done stroke rotations, neuro stands at the scanner and reads it live and decides on TPA before rads is in the room.

Of course Rads are the best trained in the field, but for the neuro example, unless its a subspecialized neuro rad they trust, neuro will usually just interpret it themselves. You see this with even more specialized fields (like the stroke example I gave, or the MS specialists who see one thing all day every day. Sure they'll miss a thyroid mass, but the MS management decisions often come down to the specialists read of the image).

At Ottawa and in where I have worked in the US the stroke team and the on call radiologist are all at the scanner when a code stroke is performed (same with trauma studies except the trauma team is there rather than neuro). The study is read by the radiologist but also of course the stroke team are all there too. That is how I also will run my practise for stoke codes as well when I start in the summer. part of that is for pure technicality - the neurologist cannot order contrast technically for a study - only the radiologist can so we are there to actually allow the CTA to proceed. That is a fine point that is often overlooked in the heat of the moment - sometimes although very rarely to bad effect ha.

It is also a very good idea for two people to read a critical study anyway - I have caught serious errors by the reading neurology team, and there is the chance they can do the same the other way and we can learn from each other. At the time of the study I also get the full history from the neuro team as well which helps me a lot reading the study.  I view any centre NOT doing something similar in the year 2020 to be one that isn't living up to modern practise standards (now that is of course my opinion as an emergency radiologist). Once the study is read at the scanner we were required at ottawa to review it with the on call neuroradiology fellow or staff (depending on who is on). We also have neuroradiology coverage in house by staff from 7am to midnight. In the US we have emergency radiology coverage by staff 24/7 and provide nighthawk services for hospitals that cannot provide those staffing. In many places in the US those sort of read structures are required by guideline, and also by law actually. None of this "hours later" crap ha. We literally count minutes from ER arrival team and are punished it we don't hit targets.  

The point is that if radiology provides the appropriate service then the entire problem mostly goes away. Not just for stroke codes, but for any critical imaging study (of which there are many).  Reading stroke studies is clearly in the realm of general radiology as well - the vast majority of them read country wide would not be read by subspecalist neuroradiology after all. They aren't that complex of a study to interrupt by a properly trained radiologist doing them regularly. The issue in academic centres not set up to manage these you either have a resident with variable experience level, on call neuroradiology which is hard to do 24/7 or another radiologist who in a subspecialist land of academia doesn't read neuro studies regularly. That why emergency radiology as a field is now a pretty hot field (when I started this it was a big risk - I am glad it seems to be working out ha). We can serve as both the on call "everything else" as well as neuroradiology emergencies. 

Edited January 19, 2020 by rmorelan

[NeuroD]

4 hours ago, rmorelan said:

At Ottawa and in where I have worked in the US the stroke team and the on call radiologist are all at the scanner when a ...

I would agree that that sort of "emergency radiology" is ideal (and I hope your field grows). My point still stands though, what of the many cases where management decisions are made based on a subspecialtist's interpretation? It's still quite common, and not just in neuro/stroke. Should that work continue to go unpaid? Especially when there are major discrepancies in relativity?

And it's not just with rads. For example, many acute decisions are made based on ECGs, but billings go to a cardiologist who interprets them much later. It's a recurrent theme. Perhaps it wouldn't matter so much if relativity wasn't skewed so heavily.

[Lactic Folly]

52 minutes ago, PhD2MD said:

I would agree that that sort of "emergency radiology" is ideal (and I hope your field grows). My point still stands though, what of the many cases where management decisions are made based on a subspecialtist's interpretation? It's still quite common, and not just in neuro/stroke. Should that work continue to go unpaid? Especially when there are major discrepancies in relativity?

Sure, I certainly don't disagree with addressing relativity for consults that are undervalued for the time spent. However, you'd need to create a new billing code for what you describe, as the current MRI codes include more than just looking at the images and making a management decision. The obvious point that you already mentioned is that the formal written interpretation takes on full legal responsibility for flagging the lung mass seen on the spine MRI localizer views (which may be curable at an early stage, but not so much if missed and the diagnosis is delayed). I just saw a case of this a couple of weeks ago.

There's also everything that goes into running an MRI department and ensuring quality of the imaging performed. This includes supervising and training technologists, developing and updating protocols and policies, staying on top of and up-to-date with safety issues, managing technical failures, attending numerous hospital meetings to deal with process and capacity issues, protocolling requests (including the time spent taking many phone calls from people upset about wait times, and in the worst case scenario having to choose which outpatient in the waiting room to send home when there's an emergency add-on, etc.) These are all included in the professional component of the service.

[rmorelan]

2 hours ago, PhD2MD said:

I would agree that that sort of "emergency radiology" is ideal (and I hope your field grows). My point still stands though, what of the many cases where management decisions are made based on a subspecialtist's interpretation? It's still quite common, and not just in neuro/stroke. Should that work continue to go unpaid? Especially when there are major discrepancies in relativity?

And it's not just with rads. For example, many acute decisions are made based on ECGs, but billings go to a cardiologist who interprets them much later. It's a recurrent theme. Perhaps it wouldn't matter so much if relativity wasn't skewed so heavily.

that is true - and although I think the solution is probably better that the respective subspecialities should "get off their asses and do their job" if I may be blunt, there should be some way of dealing with the cases you are mentioning. I think the issue is that while you may look at the imaging from a stroke perspective you cannot by desire, training, or agreement to take on the risk of reading the entire study (miss that 2-3mm PComm aneurysm while you are worried about the M1 clot in the middle of a busy stroke code and when it burst after growing for 10 years you are in big trouble). The government doesn't seem to like to be charged twice for the same thing - a prelim and a final read in this case. 

and thanks ha - it is growing as a field because it has to. Both of the major trauma centres in TO as of this year now have full emerg radiology groups, and soon both will operate 24/7 with full staff coverage. 

[HounsfieldUnit]

On 1/14/2020 at 2:03 PM, Raptors905 said:

I mean large community hospitals to be more acurrate. 
 

places like Brampton, Mississauga, Waterloo, Scarborough etc. They are all in and around that mark in general. Just check the Toronto star 

GTA rads salaries vary hugely, even within the U. Toronto.  U. Toronto has four practice groups centrally: St. Mike's (now Unity Health), Sick Kids, JDMI and Sunnybrook.  Each group offers different average salaries, and these differ depending on post and licensing (the latter, for example, if you are an IMG and did not take the Canadian board exams, then you can practice at U. Toronto, but will receive a lower salary than your colleagues).  The average salaries range from lowest to highest as follows: Sick Kids, Sunnybrook, JDMI, then St. Mike's.  The range is approximately $300K-$750K.  Community hospital groups offer higher salaries.  For example, a friend of mine works for one of them and was making $90K/month during their first year, which was 75% of the partnership salary.  They made partnership the following year, so, $120K/month.

[Grtstrng]

Very interesting discussion here. I found this compensation disclosure data for Manitoba, and if you google the names earning over a million they're almost all radiologists. Does anyone know how much of that 1 million would go to overhead?

https://www.gov.mb.ca/health/annualreports/docs/1920.pdf

[HounsfieldUnit]

16 hours ago, Grtstrng said:

Very interesting discussion here. I found this compensation disclosure data for Manitoba, and if you google the names earning over a million they're almost all radiologists. Does anyone know how much of that 1 million would go to overhead?

https://www.gov.mb.ca/health/annualreports/docs/1920.pdf

None.  Community radiologists can, and do, make seven figures.  To wit, an old colleague of mine, in their first year of community practice, was pulling in $90K per month, which was at 75% partnership.  The following year they went to 100%.  Do that math.