The use of volume standards in health services.

The ways in which volume standards are implemented by health services organizations are not clear. Therefore, the authors sought to evaluate the extent of use of volume standards, the purposes for which such standards were developed, and the sources of the standards in a sample of health services organizations. The authors found that volume standards were used widely by accrediting organizations, professional societies, and hospitals in their sample, but almost never by health maintenance organizations. Volume standards were used for ensuring adequate experience among residents, providing guidelines to residency programs, and privileging and credentialing physicians. Expert consensus appeared to be the usual source of volume standards.

Initial employment experiences of 1997 graduates of radiation oncology training programs.

PURPOSE: To inform the profession of current trends in the job market, the American College of Radiology (ACR) sought to detail the job-hunting experiences and outcomes of 1997 graduates of radiation oncology training programs. METHODS AND MATERIALS: In early 1998, questionnaires were mailed to all graduates; 67% responded. Results were compared with similar surveys of 1996 graduates. RESULTS: Similar to past years, immediately after graduation, 13% of residency graduates and 1 of 10 fellowship graduates encountered serious employment difficulties--that is, spent some time working locums, working outside radiation oncology, or unemployed. By 6-12 months after graduation, approximately 2% of all residency graduates were working outside the profession and approximately 3% were not working at all. Eighty-five percent of residency graduates and 7 of 8 fellowship graduates reported that their employment reasonably matched their training and individual goals. On average, graduates' actual salaries approximately corresponded to expected salaries. Eleven percent of all graduates were in nonownership-track jobs, a significant decline since 1996. For residents and fellows combined, 46% had a job with at least one characteristic some observers associate with a weak job market, but fewer than half of those with one of these characteristics actually disliked it. These percentages are similar to 1996. Women graduates were more likely than men to have spouse-related restrictions on job location but less likely to end up in a self-reportedly undesirable location. CONCLUSION: Unemployment remained low. Some other indicators of the employment market showed improvement, while others did not.

The status of radiation oncology training programs and their graduates in 1999.

PURPOSE: To keep the profession apprised of current trends in the job market, the American College of Radiology (ACR) studied the employment situation of 1999 radiation oncology graduates and the status and plans of radiation oncology training programs. METHODS AND MATERIALS: During mid-April to the beginning of June 1999, the ACR surveyed all radiation oncology residency directors about the employment situation of their residency and fellowship graduates, changes in their programs, and incoming trainees. Eighty-four percent (74/88) responded. We compared current findings to those of similar surveys conducted over the 1995-1998 period and report statistically significant differences (p < or = 0.05. RESULTS: Directors responded that as of the survey date, 88% (71/81) of all residency graduates had secured commitments for a position, about the same as reported throughout the 1995-1998 period. Planned and accomplished changes in residency program size since 1993 will reduce the annual number of beginning residency slots by approximately 33. This represents about a 20% decrease in the number of graduates relative to the 160 typical during the early 1990s. Residency directors' perceptions of the job market were optimistic, with 40% viewing the market as "somewhat" or "much" better than in recent years vs. 13% viewing it as worse, much as in 1998. On average, directors viewed 1999's residency applicants as, if anything, somewhat better than those who had applied one or three years earlier. CONCLUSION: Directors' perceptions of graduates' job prospects remain optimistic, and the employment situation remains the same as in past years, when reported unemployment was approximately 1%-2% or less by six months after graduation.

1997 Graduates Speak: initial employment experiences of residency and fellowship graduates.

OBJECTIVE: The American College of Radiology sought to detail the initial employment experience of 1997 diagnostic radiology graduates and recent trends. MATERIALS AND METHODS: In early 1998, questionnaires were mailed to all graduates; 65% responded. Results were compared with similar surveys of 1995 and 1996 graduates. RESULTS: Much as in past years, immediately after graduation 4% of residency graduates and 9% of fellowship graduates spent some time working as a locum tenens, working outside radiology, or unemployed, but by 6-12 months after graduation, 2% or fewer were not employed. The median fellowship graduate's salary was 5% greater than in 1996. Twelve percent of fellowship graduates were in non-ownership-track jobs, much the same as in earlier years. Thirty-two percent had one or more of 12 possibly undesirable job characteristics, down from 39% in 1996; 14% not only had, but actually disliked, one or more of these characteristics, much the same as in 1996, but down from 23% in 1995. Multivariate analysis showed that women graduates were more likely than men to have had serious employment difficulties in the immediate postgraduation months; and that graduates having a spouse who also had to find a job in the same area were more likely than others to be in a putatively "seriously undesirable" location or in "holding pattern" employment while looking for something better or more permanent. CONCLUSION: Unemployment remained very low. Some other indicators of the employment market showed improvement. Factors expected to affect employment outcomes-for example, training program quality or having major non-spouse-related restrictions on job location-had surprisingly little effect.

The status of diagnostic radiology training programs and their graduates in 1999.

OBJECTIVE: To address job market concerns, the American College of Radiology studied the employment of 1999 graduates from diagnostic radiology training programs and the programs' status and plans. MATERIALS AND METHODS: In late April to the beginning of June 1999, the American College of Radiology surveyed a 50% random sample of diagnostic radiology residency directors about the employment status of their 1999 residency and fellowship graduates as well as about plans for their training programs. Seventy-seven percent responded. We compared findings from the 1999 survey with similar findings from earlier surveys using a p value of less than or equal to 0.05 to define statistical significance. RESULTS: As of the survey, 95% of residency graduates and 96% of fellowship graduates were reported to have commitments for positions. Ninety-two percent of graduating residents and 95% of graduating fellows reportedly had commitments for positions that reasonably matched their training and personal goals. Completed plus planned changes in residency program size since 1993 would, if implemented, lead to an 8% reduction. Similar to previous years, 96% of the beginning-year residency slots were filled. Program directors reported that the job market had improved compared with that of recent years. The percentage of graduating fellows with commitments for positions was similar in almost all fields. CONCLUSION: Fellows found jobs earlier than in past years, when unemployment among graduates decreased to 1-2% by 6 months after graduation. Results in 1999 should be at least as good. Employment prospects across all subspecialties are about the same. Planned program reductions are much smaller than those reported in 1998 and may continue to evaporate.

The situation of radiation oncology practice training programs and their graduates in 1998.

PURPOSE: To keep the profession apprised of current trends in the job market, the American College of Radiology (ACR) studied the employment situation of 1998 radiation oncology graduates and the status and plans of radiation oncology training programs in the United States. METHODS AND MATERIALS: In April-May 1998, and again in a December 1998-January 1999 follow-up, the ACR surveyed all radiation oncology residency directors in the U.S. about the employment situation of their 1998 residency and fellowship graduates as well as changes in their programs. Eighty-five percent (71/84) of those surveyed responded. We compare current findings with similar 1997 and earlier surveys and report statistically significant differences (p < or = 0.05). RESULTS: By 6 months after graduation, there were no graduating residents or fellows who had not secured a position, although the status of two was unknown. At that time, about 93% of all graduates had secured positions that directors said reasonably matched graduates' training and personal goals. Program directors reported that accomplished and planned changes in their programs will reduce the annual number of residency graduates by about one-fifth since 1993. However, the number of beginning residency positions offered in 1998 was 149, up from 116 in 1997 and only a few percent below the 1993 level. By the December 1998-January 1999 follow-up, fill rates for offered training positions were 94% for residencies and 80% for fellowships, figures that are similar to those reported for past years. Directors' perceptions of the job market are much more positive. For example, only 11% of residency directors viewed the market as more difficult this year than typical of recent years, as against 48% in 1997 and 82% in 1996. CONCLUSION: Unemployment continues to be low, and another, "softer" indicator, the job market perceptions of residency program directors, continues to improve. Possibly as a result, plans for program reductions are evaporating.

Hiring of diagnostic radiologists in 1997.

OBJECTIVE: We sought to determine the hiring activities of physician groups with respect to diagnostic radiologists. MATERIALS AND METHODS: A survey was mailed to a stratified, random sample of 589 groups of physicians in the autumn of 1997; 76% responded. Responses were weighted to represent all practices in the United States that have more than one radiologist. Findings were compared with results of similar, previous surveys. RESULTS: In the 12 months before the survey, groups sought to hire 1909 (+/-111[SE]) diagnostic radiologists; 888 (+/-77) of these jobs were new positions, the rest were replacements for radiologists who left groups. Groups did not seek to refill another 366 (+/-57) positions that had been vacated during these 12 months. Groups succeeded in hiring 1488 (+/-92) diagnostic radiologists. Generally, the percentage of available positions that groups succeeded in filling did not differ among subspecialty fields. A greater perceived effect of managed care on a group was associated with fewer expansion positions and less likelihood that positions were offered on a partnership-track basis but otherwise was unrelated to hiring activity. Eighty-one percent of available positions were in groups that preferred recently trained radiologists to those with 10-20 years' experience; 28% of full-time positions in private nonacademic groups were not partnership-track. CONCLUSION: The decline in hiring evident during 1991-1995 has reversed. In the year ending in the autumn of 1997, for the first time in recent years, positions available exceeded radiologists to fill them; the excess was approximately 278 positions.

Initial employment experience of 1996 graduates of diagnostic radiology and radiation oncology training programs.

OBJECTIVE: The American College of Radiology sought to detail the initial employment experience of 1996 diagnostic radiology and radiation oncology graduates, the actual effect of factors expected to generate poor employment outcomes, and trends since 1995. MATERIALS AND METHODS: In autumn 1996, questionnaires were mailed to all graduates; 69% responded. The results were compared with a similar survey of 1995 graduates. RESULTS: After graduation, 3-10% of graduates, depending on their field (diagnostic radiology or radiation oncology) and level (residency or fellowship), spent some time working as a locum tenens, working outside their field, or unemployed. However, by a year after graduation, working outside one's field and unemployment had virtually disappeared, even among graduates unable or unwilling to relocate. The Professional Bureau of the American College of Radiology was the most widely used major job search method and drew relatively favorable ratings. At least 15-22% of graduates in posttraining employment had, and disliked, one or more of 11 job characteristics many observers regard unfavorably. Most commonly, the graduates' objection was to having too few patients to remain busy. Relatively poor job outcomes were associated with having a spouse who had to find a job in the same locality as the graduate (only salaries were impaired) but not with other locational constraints, with inadequacy of a major aspect of the training program (as reported by the graduate), and with being female. Changes from 1995 were few, and median salaries were approximately the same as in 1995. CONCLUSION: The employment situation is basically stable, but salaries seem to be lagging behind inflation. Female graduates' poorer employment outcomes are worrisome, especially because studies of women in other professions generally find, unlike our study, that women start their careers even with men.

U.S. radiologists' workload in 1995-1996 and trends since 1991-1992.

PURPOSE: To measure U.S. radiologists' workload and the variation and trends in workload. MATERIALS AND METHODS: A stratified, random sample of 794 radiology practice groups were surveyed about hiring and workload in 1996; 78% responded. Responses were weighted to represent all U.S. radiologists. Types of procedures performed in Medicare patients in 1991 and 1995 were analyzed. RESULTS: In 1995-1996, the average workload per full-time equivalent diagnostic radiologist was 11,600 procedures +/- 200 (standard error) annually, an apparent (but not statistically significant) 5% increase from 4 years earlier. Average relative value units per Medicare procedure increased by 8%, due to the increasing role of magnetic resonance imaging, computed tomography, and interventional radiology. The annual average number of procedures varied substantially by group type (e.g., 13,200 procedures +/- 500 in groups of two to four radiologists vs 10,300 +/- 300 in groups of 11 or more radiologists). Within any group type, radiologists at the 75th percentile in terms of workload typically performed at least 50% more procedures than did radiologists at the 25th percentile. CONCLUSION: Given the large variability in the annual number of procedures within and across group types, averages should not be taken as norms. Contrary to concerns about a possible surplus of radiologists, the workload per radiologist has increased substantially in the past few years.

Impact of MR imaging on nationwide health care costs and comparison with other imaging procedures.

OBJECTIVE: We wished to determine the extent to which MR imaging contributes to the overall costs of imaging in the United States and to compare MR imaging costs with other imaging techniques. MATERIALS AND METHODS: All 23 current procedural terminology, version 4 (CPT-4) codes for MR imaging were extracted from the national 1993 Part B Medicare annual data reimbursement file. For each code, we calculated total Medicare physician reimbursements. Aggregate reimbursement for all MR imaging was compared with aggregate reimbursement for all 659 imaging-related current procedural terminology, version 4 codes and also with comparable figures for echocardiography and other categories of cardiovascular imaging. RESULTS: Within the 23 MR imaging codes, 1,449,911 examinations were performed on Medicare patients in 1993, for which physicians were reimbursed $370 million. Medicare reimbursement of physicians for all 659 imaging-related procedures was $5.3 billion. Thus, MR imaging accounted for only 7% of all imaging costs. By comparison, a group of just 10 imaging codes, which are primarily cardiovascular in nature, accounted for $1.67 billion, or 32% of the entire Part B costs for imaging. Reimbursements for echocardiography alone are more than twice those for MR imaging. CONCLUSION: From the national perspective, MR imaging does not appear to warrant its reputation as a costly procedure. The costs of echocardiography and other imaging related to the cardiovascular system are considerably higher.

Graduates speak: the employment experience of 1995 graduates of diagnostic radiology and radiation oncology training programs.

PURPOSE: To determine the initial employment experience of 1995 graduates of radiology programs. MATERIALS AND METHODS: A questionnaire was mailed to all graduates of radiation oncology programs and to a stratified, random sample of 600 graduates of diagnostic radiology programs. The final response rate was 66%. RESULTS: After graduation, 4%-10% of graduates worked for a period as locum tenens, worked in a job unrelated to radiology, or were unemployed. Immediate postgraduation unemployment was 2%-5%; 7-12 months later, it was less than 0.5%. Median actual salary was approximately equal to median expected salary. Radiation oncology fellowship graduates often had poorer outcomes. Almost half of the graduates with posttraining employment had a job with at least one characteristic regarded as unfavorable by some commentators (most commonly, undesirable location or no opportunity to become a partner), and at least one-fifth had and disliked such a characteristic. Geographic constraints, including the need to find employment for a spouse or companion, did not adversely affect employment outcome. CONCLUSION: Eventual unemployment was low, and starting salaries have not collapsed. Generally, the implications of job characteristics are best assessed by monitoring trends, but the prevalence of non-partnership track employment may well have increased.

The demand side of the job market for diagnostic radiologists and radiation oncologists: hiring by physician groups in 1995.

OBJECTIVE: The American College of Radiology sought to assess the hiring activities of radiology groups in 1995, the 1995 employment market for diagnostic radiologists and radiation oncologists, and changes in the employment market since 1991. MATERIALS AND METHODS: We mailed surveys about recruitment and hiring to a stratified random sample of 600 radiology groups in the United States; 85% responded. The responses were weighted to show what they would have been if all of the approximately 3150 radiology groups in the United States had answered the survey. The findings were compared with similar surveys conducted in 1994 and 1991. RESULTS: In 1995, 31% (+/- 1% [SE]) of radiology groups actively recruited diagnostic radiologists or radiation oncologists, seeking to fill 1423 (+/- 119) openings. These figures represent a progressive decline from the 50% of groups recruiting and 2255 positions offered in 1991. In 1995, radiology groups filled 85% of available positions, compared with 76% in 1994 and 71% in 1991. In 1995, positions available because of expansion of radiology groups numbered 613 (+/- 73), considerably fewer than the estimated 720-position increase that takes place each year in the number of posttraining diagnostic radiologist and radiation oncologists in practice. In 1995, general diagnostic radiology accounted for approximately 48% of the full time-equivalent radiologists sought; radiation oncology, 11%; and the diagnostic subspecialties, 41%. We found few statistically significant differences among specialty and subspecialty fields in the percentage of available positions filled. Private, nonacademic groups offered 77% of their positions on a partnership track basis. Groups strongly affected by managed care recruited fewer radiologists and offered fewer expansion positions than similar groups that were less affected by managed care. However, managed care did not influence whether positions were offered on a partnership basis. CONCLUSION: Available positions continued to decline, and the shortfall of expansion positions relative to the annual growth in the workforce may generate serious employment problems. Managed care is having a negative effect on employment opportunities for radiologists. Gaining employment remains about equally difficult, regardless of field. The approximately 200 positions that remained unfilled at the end of the 1995 hiring season did not result from a mismatch between radiologists' skills and the qualifications that radiology groups were seeking.