Rads 2014 Unfilled spots

[supafield]

On a related note, I had a meeting with my career counselor recently and inquired as to why radiology seemed to be somewhat falling out of favour - whereupon I was immediately and rather forcefully informed that the specialty was only getting more and more competitive to match into. The counselor described the unmatched spots as "anomalies" that did not reflect the true level of competition.

 

Not quite sure what to believe at this point. Maybe the counselor just wanted to warn me against falling back on hopes of things getting easier.

 

Your counsellors serve both the role of advising you and helping the school have successful match statistics.

 

Following a bad match year for the class, it's not a big surprise that you're getting a forceful message that everything is competitive, take nothing for granted.

 

That said, while it's wrong to say the field is become increasingly competitive, I certainly wouldn't count on radiology spots being easy to come by in the future based on what happened this year.

[albmeds]

It seems like radiology is at a crossroads. In Alberta, I have spoken to many doctors who say the workload will increase with a reduction in pay (not sure how much reduction). There is also talk of 24 hour call in house that apparently started at some locations in Canada.

[mavrik13]

It seems like radiology is at a crossroads. In Alberta, I have spoken to many doctors who say the workload will increase with a reduction in pay (not sure how much reduction). There is also talk of 24 hour call in house that apparently started at some locations in Canada.

 

Honestly, I doubt both the workload will increase and pay will decrease. Diagnostic rads is overpaid as it stands right now. The median in Ontario is close to 450k, with the top 10% earning over 900k! Top 25% earning over 750k. I'm sure they are working busy days +/- call duties... but even still. The PDF that has this information is broken, but here is a (****ty) version from ICES: http://www.ices.on.ca/flip-publication/payment-to-ontario-physicians-from-ministry-of-health-and-long-term-care/index.html#138/z

 

I wouldn't be surprised to see a drastic cut in rads fee codes, but regardess, if dropping from a median salary of $450k to $350k is enough to scare you off from the field, you are in the field for the wrong reasons. Also keep in mind, a salary of $350k without overhead is far better than most other physicians pull in.

[keith_015]

The talk lately by the radiological world is to make themselves value worthy. They seem to be predicting that a shift will happen in the future. Will that shift be fee cuts? Reducing in house radiologists? Further turf wars encroaching on radiologists' work? All of the above? Who knows.

 

If fees do cut, I can only see this work against the job market further. Some radiologists who are used to making what they do may try to protect that by increasing their volume, which in a way takes away potential work from a newer trained grad.

 

It likely is true the value of rads increased much like the payment of cataract surgery due to newer technology. Back when radiologists read plain films literally, it was likely quite a time waster, so they were probably comped as such. Now with the rapid access to PACS hopefully everywhere, and the speed at which they can access films, efficiency is comped quite well. Probably the reason the Ontario government targeted those two areas. With skyrocketing volume of films and health care costs always rising, I predict rads will continue to be the target of fee cuts.

[Madz25]

The actual fee hasn't changed (or has reduced). It's the volume that has gone up, hence the so-called "over paying" of radiologists. Radiologists don't control who orders what. They do control whether or not the ordered studies get done, though. But have you worked in a hospital recently? Trying to talk to someone out of ordering something unnecessary is like pulling teeth (a lot of imaging studies are unnecessary). It's easier to just do it rather than have a 20 minute discussion as to why someone shouldn't order a study. Often, the clinician will just come back later that day or another day to talk to a different radiologist who will agree to do the study anyway. It's bad patient care, I agree, but that's how it's done. I realize that sometime's ordering studies is a way to make the patient happy.

 

Believe it or not, or argue against this if you'd like, but radiology has replaced the physical exam in some ways. Radiologists are triaging patients and decisions are based on what our reports say. In essence, we take on the responsibility of what happens to that patient. Oh you have metastatic disease? Let's see... oh there was a tiny ditzel on a study from 4 years ago that the radiologist missed. What other specialty can you go back and see a mistake? As a med student or resident that sees a patient on call - you write down lung fields are clear. In the morning, your staff says there are crackles in the right lung base. There is no way to prove that those crackles were or were not there the night before, whether or not you did your physical exam correctly. All surgeries are not videotaped to catch every little mistake. This, unfortunately, is not the case in radiology. Everything you miss is free for someone else to see later on. Not just fellow radiologists, but anyone with access to the images. The responsibility on radiologists has increased and you're calling for a cut in wages?

 

Yes, PACS has made things faster. Better scanners have made things faster. A CT used to take 20 minutes to spit out 8 images, and now it spits out 500+ images in a few seconds. Not to mention, multiphase studies with the usage of IV contrast gives you a few thousand images to wade through. How has that made my life faster than the 8 blurry images on a printed out film of yesteryear?

 

End of my rant.

 

Madz

 

P.S. If you couldn't tell, I'm in radiology.

[hydes79]

The actual fee hasn't changed (or has reduced). It's the volume that has gone up, hence the so-called "over paying" of radiologists. Radiologists don't control who orders what. They do control whether or not the ordered studies get done, though. But have you worked in a hospital recently? Trying to talk to someone out of ordering something unnecessary is like pulling teeth (a lot of imaging studies are unnecessary). It's easier to just do it rather than have a 20 minute discussion as to why someone shouldn't order a study. Often, the clinician will just come back later that day or another day to talk to a different radiologist who will agree to do the study anyway. It's bad patient care, I agree, but that's how it's done. I realize that sometime's ordering studies is a way to make the patient happy.

 

Believe it or not, or argue against this if you'd like, but radiology has replaced the physical exam in some ways. Radiologists are triaging patients and decisions are based on what our reports say. In essence, we take on the responsibility of what happens to that patient. Oh you have metastatic disease? Let's see... oh there was a tiny ditzel on a study from 4 years ago that the radiologist missed. What other specialty can you go back and see a mistake? As a med student or resident that sees a patient on call - you write down lung fields are clear. In the morning, your staff says there are crackles in the right lung base. There is no way to prove that those crackles were or were not there the night before, whether or not you did your physical exam correctly. All surgeries are not videotaped to catch every little mistake. This, unfortunately, is not the case in radiology. Everything you miss is free for someone else to see later on. Not just fellow radiologists, but anyone with access to the images. The responsibility on radiologists has increased and you're calling for a cut in wages?

 

Yes, PACS has made things faster. Better scanners have made things faster. A CT used to take 20 minutes to spit out 8 images, and now it spits out 500+ images in a few seconds. Not to mention, multiphase studies with the usage of IV contrast gives you a few thousand images to wade through. How has that made my life faster than the 8 blurry images on a printed out film of yesteryear?

 

End of my rant.

 

Madz

 

P.S. If you couldn't tell, I'm in radiology.

 

I agree 100% with everything you mentioned above! Well said!

 

If the government can crack down on unnecessary imaging studies and make the ordering clinicians pay a penalty for these studies, It will make them think twice before asking for unnecessary studies! The problem is that it's difficult to measure/decide which study was warranted and which study was not. When the government decided it will not pay for lumbar spine radiographs performed for back pain unless the patient meets certain criteria, the clinicians learned quickly to "modify" their history to get the study done!

 

Hydes79

[Madz25]

I agree 100% with everything you mentioned above! Well said!

 

If the government can crack down on unnecessary imaging studies and make the ordering clinicians pay a penalty for these studies, It will make them think twice before asking for unnecessary studies! The problem is that it's difficult to measure/decide which study was warranted and which study was not. When the government decided it will not pay for lumbar spine radiographs performed for back pain unless the patient meets certain criteria, the clinicians learned quickly to "modify" their history to get the study done!

 

Hydes79

 

Agreed. History modifying is unbelievable. Nobody follows Ottawa ankle rules, Canadian CT head or c-spine rules. Studies are often ordered before blood work has even been drawn! Pain = scan to "rule out badness."

[albmeds]

Does anyone know how the rads American match was? Did they also have a number of unfilled spots or has the interest remained consistent there?

[A-Stark]

This reminds me about a joke about one of the emerg staff at my centre, where you get a consult about about an 80 year old female with SOB - CT head normal.

[JoshH]

Does anyone know what is the current job status in Canada for radiology? How hard is to find a job after residency?

[NLengr]

This reminds me about a joke about one of the emerg staff at my centre, where you get a consult about about an 80 year old female with SOB - CT head normal.

 

If you are at the same center as I think you are, one of the IM staff used to be famous for CT chest/abdo/pelvis for a huge number of patients.

[astudentis]

Oh man, I havnt been on this site for almost a year now. But yea I totally agree w Madz... imaging is replacing clinical decision making, which is kind of ridiculous. I have seen some patients get daily CXR, maybe ever BID CXR to assess improvement in effusions, etc. etc. What happened to percussion?!

 

There were instances, where clinical likelihood of someone actually having PE was low, but attending still wanted to order CTPE... As a pgy1 from rads, you have to make the call to your colleagues in the middle of the night to request the scan even though you dont think its actually going to be a positive study.

[rmorelan]

Oh man, I havnt been on this site for almost a year now. But yea I totally agree w Madz... imaging is replacing clinical decision making, which is kind of ridiculous. I have seen some patients get daily CXR, maybe ever BID CXR to assess improvement in effusions, etc. etc. What happened to percussion?!

 

There were instances, where clinical likelihood of someone actually having PE was low, but attending still wanted to order CTPE... As a pgy1 from rads, you have to make the call to your colleagues in the middle of the night to request the scan even though you dont think its actually going to be a positive study.

 

sensitivity to percussion is only 55% I heard as an example (not that we don't order way too many tests I think). That is another part of the problem - imaging is fast, easy, and vastly more accurate - even compared to the well trained. A lot of physical examination techniques are pretty bad actually when you look at how useful they really are - their advantage is they are quick, and cheap.

[A-Stark]

Oh man, I havnt been on this site for almost a year now. But yea I totally agree w Madz... imaging is replacing clinical decision making, which is kind of ridiculous. I have seen some patients get daily CXR, maybe ever BID CXR to assess improvement in effusions, etc. etc. What happened to percussion?!

 

There were instances, where clinical likelihood of someone actually having PE was low, but attending still wanted to order CTPE... As a pgy1 from rads, you have to make the call to your colleagues in the middle of the night to request the scan even though you dont think its actually going to be a positive study.

 

A lot of the time those with high pre-test probability end up having negative scans. It is not such a straightforward diagnosis to make, and I've had multiple experiences where something looked and sounded like a PE but turned out to be something else or nothing at all. Sometimes we simply start empiric therapy, but the definitive study is necessary to determine the duration of treatment (e.g. ACS +/- PE).

 

With respect to CXR, most of the time we are interpreting these as they are done, especially overnight when they won't get reported until the next day. Recently on call I had to arrange short-interval CXRs for not one but two patients who'd had chest tubes removed. Percussion isn't going to help me rule out a slowly expanding pneumo.

[ploughboy]

What happened to percussion?!

 

Bwhahaha...*slaps knees*...good one.

[NLengr]

sensitivity to percussion is only 55% I heard as an example (not that we don't order way too many tests I think). That is another part of the problem - imaging is fast, easy, and vastly more accurate - even compared to the well trained. A lot of physical examination techniques are pretty bad actually when you look at how useful they really are - their advantage is they are quick, and cheap.

 

Much of the time physical exam is no better than flipping a coin.

[Andie]

Any idea what happened at Queen's? Why did 2/3 spots go unfilled?

[tooty]

I think it's because Kingston is not a desired location. KGH is also old, and the rads dept in particular is a little dingy.

 

Otherwise, it's a great program. They get great exposure and are well trained for the royal college, proven by an excellent track record. They have very light call, which I think is under-appreciated by applicants. I did an elective there and found that all of their residents were approachable and collegial.