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Grass is always greener.....are you happy with your choice of specialty?

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  • #31
    All of this is an issue with the linearity of pay in medicine. Unless you own a practice, take a cut from other docs/midlevels, etc...you're paid essentially like an hourly worker. See pt get x, always. never more, sometimes less.

    Its even less than that ofc as you top out the marginal tax rate, which is the part I dont get as much. Why crush yourself too far into the marginal rate (if it requires extra hours/work in said specialty) if you're getting much less but of course your risk is not capped at all.

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    • #32
      Originally posted by Panscan View Post

      Volume/person is related to the desire to make money of the individual rads. Could easily read less and make less. Most rads don't want to do that.

      The amount of vacation in PP rads is frankly ridiculous compared to essentially all other specialties and employment situations. There are people literally getting 12-18 weeks off. I have never heard of a job where you get 1/3 of the year off with no call and reading an extremely narrow modality such as mammography in another specialty besides rads. It would be like if you were a general surgeon who only did appys all day and literally nothing else.

      I love rads subject matter and the job FWIW just the employment paradigms especially in private practice make no sense to me and I don't really see them repeated anywhere else in any other field of medicine. Would rather have a little less time off and not have calls be absolutely miserable where you are doing 3x FTE work. Again this is something I haven't really heard of in any other field and am not sure why it's a thing in radiology, I guess because PACS enables it? Not sure how it's legally defensible, it seems pretty clear to me you could look at normal business hours volumes and establish that as a normal volume and then if you have a mistake during a time where you are literally doing an integer multiple of that, it would look pretty bad.
      You are a resident right? Real world PP is more complicated than that, you will see.

      You'll be one voice in a group with many other radiologists. Or worse, you're in an employment scenario where your boss is not one of your partners and couldn't care less how you feel on call. Different people are obviously going to have differing opinions on the money vs lifestyle spectrum.

      Even when the group agrees, it's not so simple. My group is currently aggressively hiring. With volumes exploding everywhere there are more jobs than radiologists right now. It's not easy to get good people, and when you do get them signed it's not like they are going to start tomorrow. It takes time and our patients need their studies read in the meantime.

      And when we are recruiting, what do most new grads look at? It's location and then how much pay, how much time off, how often do I have to work on the weekend. So the group that chooses a better lifestyle and lower volumes will often be at a competitive disadvantage. It's hard for a new rad to understand "sure that job pays 100K more but you will want to quit at the end of every weekend shift" until you've been there.

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      • #33
        Originally posted by Panscan View Post

        Volume/person is related to the desire to make money of the individual rads. Could easily read less and make less. Most rads don't want to do that.

        The amount of vacation in PP rads is frankly ridiculous compared to essentially all other specialties and employment situations. There are people literally getting 12-18 weeks off. I have never heard of a job where you get 1/3 of the year off with no call and reading an extremely narrow modality such as mammography in another specialty besides rads. It would be like if you were a general surgeon who only did appys all day and literally nothing else.

        I love rads subject matter and the job FWIW just the employment paradigms especially in private practice make no sense to me and I don't really see them repeated anywhere else in any other field of medicine. Would rather have a little less time off and not have calls be absolutely miserable where you are doing 3x FTE work. Again this is something I haven't really heard of in any other field and am not sure why it's a thing in radiology, I guess because PACS enables it? Not sure how it's legally defensible, it seems pretty clear to me you could look at normal business hours volumes and establish that as a normal volume and then if you have a mistake during a time where you are literally doing an integer multiple of that, it would look pretty bad.
        Do you count weekends/holidays for time off? I looked at the numbers for my own group and each rad works 32 weekend/holidays days a year. Counting 5 days as a "week off" that's over 6 weeks of call. As a rad you know call is often worse than a regular daytime shift.

        We aim for 10-12 weeks off (not including the above weekend/holiday numbers) but any time we take a new contract that impacts time off for months. If you want to hire a new fellow he/she can't start until July. Hiring a rad already out in practice still takes 3-6 months to get credentialed. That's not counting the time to find/interview a good rad. If you hire too many and/or lose a contract you are left either with a lower salary or lowering payroll i.e. letting rads go. I don't like doing the second option at all so that means being more conservative on hiring.

        Our productivity expectations are what we set for ourselves. Rads are people and as long as they fit into an acceptable range of productivity it's fine. That's why I find private equity owned rad groups troubling- there are owners who are completely dissociated from the work generating the income. It's easy to tell the docs to work longer and faster when you don't have to pull on the chain.

        Actually having to hire, create/manage a schedule, and do payroll for a group gives you a different perspective.
        Last edited by zlandar; 06-11-2021, 07:49 AM.

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        • #34
          Originally posted by Dusn View Post

          I agree completely. I know ophthos who see 100 patients a day and they’re definitely missing stuff — they just might be working too fast to realize it. I think the patient volumes is a growing problem across medicine.

          That being said, I agree that the problem might be the worst in radiology and the number of missed critical findings in the radiology reports I see really seems to reflect the rushed way they were read. They don’t even seem to be reading the reason for the study. For family members, I don’t care what the read says any longer. I always ask for a copy of the images on a CD and ask a competent radiologist friend or family member to look at it.

          Sorry to sound like I’m bashing radiology. I think this issue of too many patients —> poor quality of care is universal across medicine, not just rads.
          It's tough to generalize a local situation to a whole specialty, but some of what you said is true in some practices. All Radiologists miss findings on occasion. We try to make it as rare as possible. I'm in a large group and there are a couple of my partners who miss a bit more than average, I wish it were different but that's the reality. As in all fields of medicine some docs are better than others.

          The thing with Radiology that's unique is that every one of our mistakes is forever out there on the image. That's not true in most of medicine. The missed heart murmur, or the palpable breast mass that didn't get palpated is never revealed to others like the missed breast cancer on a mammogram.

          The other somewhat unique thing in Radiology is that everyone (some hyperbole there) thinks they can read the image as well as the Radiologist. Its much easier to find "Waldo" once you already know where he is from reading our report. Its all part of the life. I take the good with the bad. The grass is always greener.....

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          • #35
            Originally posted by K82 View Post

            It's tough to generalize a local situation to a whole specialty, but some of what you said is true in some practices. All Radiologists miss findings on occasion. We try to make it as rare as possible. I'm in a large group and there are a couple of my partners who miss a bit more than average, I wish it were different but that's the reality. As in all fields of medicine some docs are better than others.

            The thing with Radiology that's unique is that every one of our mistakes is forever out there on the image. That's not true in most of medicine. The missed heart murmur, or the palpable breast mass that didn't get palpated is never revealed to others like the missed breast cancer on a mammogram.

            The other somewhat unique thing in Radiology is that everyone (some hyperbole there) thinks they can read the image as well as the Radiologist. Its much easier to find "Waldo" once you already know where he is from reading our report. Its all part of the life. I take the good with the bad. The grass is always greener.....
            hear hear hear, here here here here...

            The only person who doesn't miss a case is someone who doesn't look at them regularly. Even the best of them miss something. And as was stated, images are saved forever and in hindsight anyone can 'see' a lesion.

            Can you imagine if a camera hovered over a surgical room and recorded every cut, stitch and wipe? I bet many surgeons would have 'error rates' comparable to radiologist.

            How about a camera recording every ER visit?

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            • #36
              Originally posted by runfast00 View Post
              10 years in private practice FM.

              I wouldn't do it again. FM is so broad and practice creep with mid-levels. The financial liability isn't worth the financial rewards.

              Even in the first 10 years in practice I have seen less respect, less autonomy, more paperwork, and less revenue per hour in practice. And most days I still love my job because I see a difference by helping my patients become healthier or guide them through a complex disease.

              If I did it again maybe I would have done ENT or dermatology.
              do you think eventually FM, EM and the basic primary care stuff can AND should be handled by 'mid-levels' ??

              And physicians will all be specialist or even sub specialist?

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              • #37
                Originally posted by K82 View Post
                The thing with Radiology that's unique is that every one of our mistakes is forever out there on the image. That's not true in most of medicine. The missed heart murmur, or the palpable breast mass that didn't get palpated is never revealed to others like the missed breast cancer on a mammogram.
                As a pathologist whose mistakes are out there forever on a slide (or in a tissue block), I empathize.

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                • #38
                  Originally posted by STATscans View Post

                  do you think eventually FM, EM and the basic primary care stuff can AND should be handled by 'mid-levels' ??

                  And physicians will all be specialist or even sub specialist?
                  can, likely.

                  Should be, absolutely not

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                  • #39
                    Originally posted by artemis View Post

                    As a pathologist whose mistakes are out there forever on a slide (or in a tissue block), I empathize.
                    At least for 10 years

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                    • #40
                      I like my job and enjoy my work, but I think part of that is my excellent practice and partners (knock on wood). I would definitely do ortho again regardless. I think I woulda been happy with plastics or ENT too as I have several friends in those specialties.

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                      • #41
                        Originally posted by STATscans View Post

                        do you think eventually FM, EM and the basic primary care stuff can AND should be handled by 'mid-levels' ??

                        And physicians will all be specialist or even sub specialist?
                        Do you want a mid level as your PCP?

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                        • #42
                          Originally posted by runfast00 View Post
                          10 years in private practice FM.

                          I wouldn't do it again. FM is so broad and practice creep with mid-levels. The financial liability isn't worth the financial rewards.

                          Even in the first 10 years in practice I have seen less respect, less autonomy, more paperwork, and less revenue per hour in practice. And most days I still love my job because I see a difference by helping my patients become healthier or guide them through a complex disease.

                          If I did it again maybe I would have done ENT or dermatology.
                          FP over 30 years and I have to agree with this. Family medicine has changed so much. If I could do it over I would go with GI or ophthalmology, though I'm sure they can become a grind like anything else.. I really enjoyed doing flex sigs way back when and enjoyed my optho rotations quite a bit. Sounds like optho has changed a lot though based on some of the posts.

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                          • #43
                            I'd pick radiology 9 times out of 10. I'd probably pick some surgical subspecialty the 10th time (ortho probably). I get to know some esoteric stuff and use it. I talk to a variety of clinicians. It's nice to make a good call sometimes and be helpful. My days are busy, which is preferred. Pay is better than many. Lots of vacation time to learn other stuff.

                            Drawbacks- probably not a good subspecialty if you get a lot out of people telling you do a good job. That is pretty rare.

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                            • #44
                              Originally posted by STATscans View Post

                              do you think eventually FM, EM and the basic primary care stuff can AND should be handled by 'mid-levels' ??

                              And physicians will all be specialist or even sub specialist?
                              Good question. I do colonoscopy/EGD in my FM practice and at a recent CME conference I heard that in England those 'simple' procedures are now being handled by nurses since 'routine procedures' are 'routine'.

                              I'd like to think I am compensated for the risk and the cognitive work of a complex diagnosis [recent example: low back pain turned out to be metastatic ovarian cancer]

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                              • #45
                                Originally posted by STATscans View Post

                                do you think eventually FM, EM and the basic primary care stuff can AND should be handled by 'mid-levels' ??

                                And physicians will all be specialist or even sub specialist?
                                I’m FM. I do see midlevels taking complete control over primary care(FM, peds) in the next 20-30yrs. I’m not saying it’s right, it’s just how it’s going ., admin profits more from employing midlevels even if midlevels reimbursement is 85% of a physicians reimbursement.
                                no wonder there’s a big corporate practice opening nearby and they want to staff the clinic w 1 doc, 2 midlevels. Tells you everything u need to k is right there...

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