Radiology Practice Consolidation: Fewer but Bigger Groups Over Time

PurposeThe aim of this study was to assess recent trends in US radiology practice consolidation.MethodsRadiologist practice characteristics were obtained from the Medicare Physician Compare database for 2014 and 2018. Radiologists were classified on the basis of their largest identifiable practice affiliations. Single-specialty radiology practices were identified using practice names. Temporal trends in practice sizes were assessed.ResultsAt the individual radiologist level from 2014 to 2018, the fraction of all radiologists in groups with 1 or 2 members declined from 3.2% to 2.1%, 3 to 9 members from 10.2% to 6.7%, 10 to 24 members from 18.2% to 14.1%, 25 to 49 members from 16.6% to 15.1%, and 50 to 99 members from 13.3% to 11.5%. In contrast, the fraction in groups with 100 to 499 members increased from 15.7% to 21.8% and with ≥500 members from 22.9% to 28.7%. At the practice level, the fraction of all radiologists’ practices with 1 or 2 members decreased from 26.9% to 22.8%, whereas the fraction with 100 to 499 members increased from 7.6% to 10.2% and with ≥500 members from 2.5% to 4.1%. Similar shifts were present for single-specialty radiology practices and all geographic regions nationally. The 30,492 radiologists identified in 2014 were affiliated with 4,908 group practices, including 2,812 single-specialty practices. In comparison, the 32,096 radiologists identified in 2018 were affiliated with 4,193 group practices (a 14.6% decline), including 2,216 single-specialty practices (a 21.2% decline).ConclusionsIn very recent years, the US radiologist workforce has consolidated, leading to increased practice sizes and a substantial decline in the number of distinct practices, disproportionately affecting single-specialty radiology practices. The impact of this consolidation on cost, quality, and patient access merits further attention.     

Gender and the Radiology Workforce: Results of the 2014 ACR Workforce Survey

PurposeAs part of the 2014 ACR Human Resources Commission Workforce Survey, an assessment of the gender of the U.S. radiologist workforce was undertaken. Radiologist gender in relation to type of practice, work location, leadership roles, and full- versus part-time employment have not previously been assessed by this survey.MethodsThe survey was completed by group leaders in radiology identified through the Practice of Radiology Environment Database.ResultsThe response rate to the survey was 22%, representing 35% of all practicing radiologists. The survey found that 78% of the radiology workforce is male, and 22% female. Among the men, 58% work in private practice, and 18% in the academic/university environment; among women, percentages were 43% and 31%, respectively. Of all physician leads, 85% are men, 15% women. Of the full-time radiologists, 15% of men are practice leaders compared with 11% of women.ConclusionsFewer women than men are in private practice. More women than men practice in academic/university environments. Among part-time radiologists, there are more men than women, but significantly more women work part time than men. Women are in the minority among practice leaders.     

Radiology Practices Employing Nurse Practitioners and Physician Assistants: Characteristics and Trends From 2017 Through 2019

PurposeThe number and roles of US nonphysician practitioners (NPPs) have expanded considerably, but little is known about their use by radiology practices. The authors assessed characteristics and trends of radiology practices employing Medicare-recognized NPPs.MethodsUsing Medicare databases from 2017 through 2019, the authors mapped all nurse practitioners and physician assistants (together “NPPs”) to employer groups for which all physicians were radiologists (“radiology practices”). Practices were characterized by size, geography, and radiologist characteristics. Temporal changes were assessed, and NPP employment likelihood was estimated using multivariate logistic regression modeling.ResultsAs the number of US radiology practices declined by 36.5% (from 2,643 to 1,679) between 2017 and 2019, the number employing NPPs increased by 10.5% (from 228 [8.6%] to 252 [15.0%]). The number of radiologists in NPP-employing practices increased by 10.4% (from 6,596 [35.1%] to 7,282 [40.0%]) as the number of radiology-employed NPPs increased by 17.5% (from 588 to 691). Practices were more likely to employ NPPs when medium (odds ratio [OR], 1.31) or large (OR, 1.25) in size, when urban located (OR, 1.35), and as their percentages of interventional radiologists increased (OR, 5.53 per percentage point) (P < .01 for all). Practices were less likely to employ NPPs as mean radiologist years since completing training increased (OR, 0.99 per year; P < .01).ConclusionsEmployment of NPPs by radiology practices has grown considerably in recent years, particularly in larger and urban practices and in those that employ more interventional and early-career radiologists. More work is necessary to better understand how this expanding use of NPPs affects the specialty.     

Burnout,Professional Fulfillment,Intention to Leave,and Sleep-Related Impairment Among Faculty Radiologists in the United States: An Epidemiologic Study

ObjectiveTo examine the prevalence of burnout in faculty radiologists in the United States and to explore the relationship between burnout and professional fulfillment (PF), intention to leave (ITL), and sleep-related impairment by gender.MethodsThis cross-sectional study was conducted through a voluntary anonymous, electronic survey of radiologists at 11 academic medical institutions participating in the Physician Wellness Academic Consortium between January 2017 and September 2018. Faculty radiologists who completed the survey were included in the study. The survey contained the validated professional fulfillment index and National Institute of Health Patient Reported Outcomes Measurement Information System sleep-related impairment scale. Demographics of participants only included gender to protect anonymity. Sample t tests and χ² exact tests were used for analysis with significance level set at P < .05.ResultsIn all, 456 faculty radiologists (171 women) answered the survey. The overall prevalence of burnout was 37.4%, PF was 35.6%, ITL was 33.3%, and sleep-related impairment was 45.3%. Burnout was higher in female versus male respondents (44% versus 31%, P < .05), and PF and ITL were lower (30% versus 42%, P < .05, 26% versus 38%, P < .05, respectively). When faculty were stratified into burned out versus not burned out, PF was significantly lower in those with burnout (12% versus 52%, P < .05), and ITL and sleep-related impairment was higher (51% versus 24%, P < .05 and 75% versus 30%, P < .05, respectively).DiscussionHigher burnout was associated with reports of greater ITL and sleep-related impairment and lower PF. Female radiologists experience more burnout but less ITL than their male counterparts.     

ACR and ASRT development of the radiologist assistant: concept, roles, and responsibilities

ACR and ASRT joined forces to address the workforce shortages of radiologists and radiological technologists with the development of a radiologist assistant. This paper discusses the rationale for the evolution and development of the radiologist assistant as designed by ACR and ASRT.With the profession of radiology experiencing workforce shortages among radiologists and radiological technologists many radiological groups were beginning to hire ancillary personnel to fill efficiency gaps in practices. Many academic institutions were in the process of considering programs to initiate advanced practice status for radiologic technologists. Several state legislatures were considering laws that would provide extended scope of practice technology with additional training. The ACR and ASRT entered into discussions to address these concerns in order to: (1) assure patient safety by allowing only properly trained personnel to provide radiological service to patients; (2) assure that these ancillary personnel are not allowed to practice without appropriate physician supervision; (3) assure that there are not 50 different state scope of practice laws based more on political expediency than quality patient care; (4) alleviate workforce shortages for radiological technologists by creating a professionally satisfying career path; (5) alleviate some of the time pressures placed on radiologists as a result of their workforce shortages. The ACR had a choice to lead on the development of the roles and responsibilities of the radiologist assistant or continue to allow the process to evolve as market and political pressures warranted. As a leader in the profession, the ACR believed that it was in the best interest of its members and the profession to be at the table with the development of the roles and responsibilities of the radiologist assistant to assure the best for our patients. The roles and responsibilities of the RA as approved by the ACR Council are presented.     

Professional Services Rendered by Nurse Practitioners and Physician Assistants Employed by Radiology Practices: Characteristics and Trends From 2017 Through 2019

PurposeWith radiology practices increasingly employing nonphysician practitioners (NPPs), we aimed to characterize specific NPP clinical roles.MethodsLinking 2017 to 2019 Medicare data sets, we identified all claims-submitting nurse practitioners and physician assistants (together NPPs) employed by radiologists. NPP-billed services were identified, weighted by work relative value units, and categorized as (1) clinical evaluation and management (E&M), (2) invasive procedures, and (3) noninvasive imaging interpretation. NPP practice patterns were assessed temporally and using frequency analysis.ResultsAs the number of radiologist-employed NPPs submitting claims increased 16.3% (from 523 in 2017 to 608 in 2019), their aggregate Medicare fee-for-service work relative value units increased 17.3% (+40.0% for E&M [from 79,540 to 111,337]; +5.6% for procedures [from 179,044 to 189,003]; and +74.0% for imaging [from 5,087 to 8,850]). The number performing E&M, invasive procedures, and imaging interpretation increased 7.6% (from 329 to 354), 18.3% (from 387 to 458), and 31.8% (from 85 to 112), with 58.2%, 75.3%, and 18.4% billing those services in 2019. Paracentesis and thoracentesis were the most frequently billed invasive procedures. Fluoroscopic swallowing and bone densitometry examinations were the most frequently billed imaging services. By region, NPPs practicing as majority clinical E&M providers were most common in the Midwest (33.5%) and South (33.0%), majority proceduralists in the South (53.1%), and majority image interpreters in the Midwest (50.0%).ConclusionsAs radiology practices employ more NPPs, radiologist-employed NPPs’ aggregate services have increased for E&M, invasive procedures, and imaging interpretation. Most radiologist-employed NPPs perform invasive procedures and E&M. Although performed by a small minority, imaging interpretation has shown the largest relative service growth.     

大孔吸附树脂分离纯化鲜地黄叶中梓醇的初步研究

目的：选择合适的大孔吸附树脂对鲜地黄叶中梓醇进行富集纯化。方法：以高效液相为检测手段,梓醇含量为检测指标。采用吸附和解吸试验考察了12种大孔吸附树脂对梓醇的吸附解吸性能,筛选出H103树脂进行了分离纯化研究。结果：H103树脂对梓醇具有很好的吸附解吸性能,其纯化条件为上样液浓度1mg/ml,上样体积2BV,上样吸附速度1～2BV/h,洗脱速度1～3BV/h,10%乙醇洗脱8BV。结论：采用H103树脂分离纯化鲜地黄叶中梓醇,可简化步骤,降低成本,方法简单可行。     

Renal Colic Imaging: Myths,Recent Trends,and Controversies

There has been a substantial increase in the utilization of imaging, particularly of multi-detector computed tomography (MDCT), for the evaluation of patients with suspected urolithiasis over the past 2 decades. While the diagnostic accuracy of computed tomography (CT) for urolithiasis is excellent, it has also resulted in substantial medical expenditures and increased ionizing radiation exposure. This is especially concerning in patients with known nephrolithiasis and in younger patients. This pictorial review will focus on recent trends and controversies in imaging of patients with suspected urolithiasis, including the current roles of ultrasound (US), MDCT, and magnetic resonance imaging, the estimated radiation dose from MDCT and dose reduction strategies, as well as imaging of suspected renal colic in pregnant patients. The current epidemiological, clinical, and practice management literature will be appraised.     

A County-Level Analysis of the US Radiologist Workforce: Physician Supply and Subspecialty Characteristics

PurposeTo explore associations between county-level measures of radiologist supply and subspecialization and county structural and health-related characteristics.MethodsMedicare Physician and Other Supplier Public Use Files were used to subspecialty characterize 32,844 radiologists participating in Medicare between 2012 and 2014. Measures of radiologist supply and subspecialization were computed for 3,143 US counties. Additional county characteristics were identified using the 2014 County Health Rankings database. Mann-Whitney tests and Spearman correlations were performed.ResultsCounties with at least one (versus no) Medicare-participating radiologist had significantly (P < .001) larger populations (197,050 ± 457,056 versus 20,253 ± 23,689), lower rural percentages (39.5% ± 26.5% versus 74.6% ± 25.6%), higher household incomes ($47,608 ± $12,493 versus $42,510 ± $9,893), higher mammography screening rates (62.4% ± 7.0% versus 56.6% ± 15.3%), and lower premature deaths (7,581 ± 2,085 versus 7,784 ± 3,409 years of life lost). Counties’ radiologists per 100,000 population and percent of subspecialized radiologists showed moderate positive correlations with counties’ population (r = +0.505-+0.599) and moderate negative correlations with counties’ rural percentage (r = −0.434 to −0.523). Radiologist supply and degree of subspecialization both showed concurrent positive or negative weak associations with counties’ percent age 65+ (r = −0.256 to −0.271), percent Hispanic (r = +0.209-+0.234), and income (r = +0.230-+0.316). Radiologists per 100,000 population showed weak positive correlation with mammography screening (r = +0.214); percent of radiologists subspecialized showed weak negative correlation with premature death (r = −0.226).ConclusionGeographic disparities in radiologist supply at the community level are compounded by superimposed variation in the degree of subspecialization of those radiologists. The potential impact of such access disparities on county-level health warrants further investigation.     

The Employment Experience of Recent Graduates From US Radiation Oncology Training Programs: The Practice Entry Survey Results From 2012 to 2017

PurposeThe Practice Entry Survey presentation is a highly anticipated session for the radiation oncology (RO) resident at the American Society for Radiation Oncology annual meeting. Each year the senior author reports the employment outcomes and job market experiences for the most recently graduated RO residents.MethodsThe Practice Entry Survey has been continuously administered annually to graduated RO residents since 1984 via the Association of Residents in Radiation Oncology directory. Six years of individual-level data, from 2012 to 2017, were readily available for analysis. The questionnaire queries the workforce placement experience and collects debt, salary, and benefits information. Respondents were subgrouped by practice type (academic vs private practice), and results were tested for trends over time.ResultsSurvey data were collected from 302 recently graduated residents. There were 7 in fellowship and 1 practicing internationally, leaving 294 eligible for analysis. They identified themselves as working in either an academic setting (n = 150 [51%]) or private practice (n = 144 [49%]). First-year salaries for those in private practice were more than those in academics ($303,000; [interquartile range, $270,000-$375,000] versus $280,000 [interquartile range, $260,000-$325,000]; P < .01). With regard to the job search, 21.8% of respondents found their jobs through the online American Society for Radiation Oncology Career Center, while most respondents, 77.2%, found their jobs through other means. Respondents also ranked the items they found to be most helpful during the interview process.ConclusionsThese data can help gauge the competitiveness of an offer as well as what to expect during the job hunt and interview process.     

Recent Trends Suggest Possible Inappropriate Utilization of Myocardial Perfusion Imaging

PurposeThe aim of this study was to analyze the utilization of elective stress nuclear myocardial perfusion imaging (MPI) in the Medicare population.MethodsNationwide Medicare Part B fee-for-service databases for 2004 to 2016 were reviewed. Current Procedural Terminology codes for stress MPI were selected: standard planar and single-photon emission computed tomography (STD) and PET. Utilization rates per 1,000 Medicare beneficiaries were calculated. Elective examinations were identified using place-of-service codes for private offices and hospital outpatient departments (HOPDs). Medicare physician specialty codes identified the performing physician. Because Medicare Part B databases are complete population counts, sample statistics were not required.ResultsElective STD MPI utilization peaked in 2006 at 74 studies/1,000 and had declined by 36% by 2016. Cardiologists’ share of STD MPI grew from 79% to 87% between 2004 and 2016. Cardiologists perform STD MPI primarily in private offices, where utilization peaked in 2008 and then demonstrated an absolute decline of 28 studies/1,000 by 2016. During this same time period, cardiologists’ use of STD MPI in HOPDs demonstrated an absolute increase of 8.1 studies/1,000. From 2004 to 2016, STD MPI use by radiologists declined by 58%. Elective PET MPI maintained an upward trend, reflecting increasing use by cardiologists in private offices.ConclusionsElective STD MPI use is declining, but cardiologists are performing an increasing share in outpatient settings. The drop in private office STD MPI among cardiologists was far greater than the corresponding increase in its use in HOPDs, suggesting that many studies previously performed in private offices were unindicated. Self-referred PET MPI utilization has rapidly grown in cardiology private offices.     

Value Management Program: Performance,Quantification, and Presentation of Imaging Value-Added Actions

Health care is in a state of transition, shifting from volume-based success to value-based success. Hospital executives and referring physicians often do not understand the total value a radiology group provides. A template for easy, cost-effective implementation in clinical practice for most radiology groups to demonstrate the value they provide to their clients (patients, physicians, health care executives) has not been well described. A value management program was developed to document all of the value-added activities performed by on-site radiologists, quantify them in terms of time spent on each activity (investment), and present the benefits to internal and external stakeholders (outcomes). The radiology value-added matrix is the platform from which value-added activities are categorized and synthesized into a template for defining investments and outcomes. The value management program was first implemented systemwide in 2013. Across all serviced locations, 9,931.75 hours were invested. An annual executive summary report template demonstrating outcomes is given to clients. The mean and median individual value-added hours per radiologist were 134.52 and 113.33, respectively. If this program were extrapolated to the entire field of radiology, approximately 30,000 radiologists, this would have resulted in 10,641,161 uncompensated value-added hours documented in 2013, with an estimated economic value of $2.21 billion.