Power Doppler imaging: initial evaluation as a screening examination for carotid artery stenosis.

PURPOSE: To evaluate power Doppler imaging as a possible screening examination for carotid artery stenosis. MATERIALS AND METHODS: In the principal pilot study, a prospective, blinded comparison of power Doppler imaging with duplex Doppler imaging, the reference-standard method, was conducted in 100 consecutive patients routinely referred for carotid artery imaging at a large, private multispecialty clinic. In the validation pilot study, a prospective, blinded comparison of power Doppler imaging with digital subtraction angiography, the reference-standard method, was conducted in 20 consecutive patients routinely referred at a teaching hospital. Using conservative assumptions, the authors performed cost-effectiveness analysis. RESULTS: Power Doppler imaging produced diagnostic-quality images in 89% of patients. When the images of the patients with nondiagnostic examinations were regarded as positive, power Doppler imaging had an area under the receiver operating characteristic curve, A(z), of 0.87, sensitivity of 70%, and specificity of 91%. The validation study results were very similar. The cost-effectiveness of screening and, as indicated, duplex Doppler imaging as the definitive diagnostic examination and endarterectomy was $47,000 per quality-adjusted life-year. CONCLUSION: The A(z) value for power Doppler imaging compares well with that for mammography, a generally accepted screening examination, and with most other imaging examinations. Power Doppler imaging is likely to be a reasonably accurate and cost-effective screening examination for carotid artery stenosis in asymptomatic populations.

Diagnostic radiologists' subspecialization and fields of practice.

OBJECTIVE: The purpose of this study was to explore the diagnostic radiology profession from the perspective of subspecialization and fields of practice. MATERIALS AND METHODS: Data for 1244 practicing diagnostic radiologists were gathered from the American College of Radiology's 1995 Survey of Radiologists. Radiation oncologists, the retired, and residents and fellows were excluded. Responses were weighted to represent all practicing diagnostic radiologists in the United States and were compared with a similar previous survey. RESULTS: More than one quarter (28%) of diagnostic radiologists are subspecialists. Diagnostic radiology subspecialists were more likely than generalists to have fellowship training, work in center cities, work in large groups, and be employed by an academic institution. They were also generally younger and provided a narrower range of imaging services than generalists. CONCLUSION: Although most diagnostic radiologists are generalists, subspecialization will likely continue to grow.

Professional satisfaction of U.S. radiologists during a period of uncertainty.

PURPOSE: To identify and explain variations and trends in the professional satisfaction of radiologists. MATERIALS AND METHODS: Questionnaires were mailed during the winter of 1994-1995 to a stratified random sample of 3,024 diagnostic radiologists, radiation oncologists, and nuclear medicine specialists; 75% responded. We weighted the responses to make them representative of all radiologists in the United States and compared the findings with those of similar previous surveys. RESULTS: Fifty-one percent of radiologists would recommend a career in radiology to a college-age adult, which is down from 65% in 1990 but up from 42% in 1998. Forty-one percent said they liked working in radiology less than they did 5 years ago, whereas 22% said they liked it more. Radiologists' perceptions of managed care's effect on their practice had more influence on professional satisfaction than did its administrative intrusions or the actual percentage of managed care patients in their practice. Other factors associated with decreased satisfaction were increased administrative duties and government involvement. CONCLUSION: Satisfaction in the radiology profession declined during a period of dramatic change and uncertainty. Fear about managed care rather than its actual effect was the dominant factor in the decrease. Therefore, it is unsound to predict a long-term decline in professional satisfaction.

The situation of diagnostic radiology training programs and their graduates in 1998.

OBJECTIVE: In light of concerns about the job market, the American College of Radiology studied the employment situation of 1998 graduates from diagnostic radiology training programs and the status and plans of the programs. MATERIALS AND METHODS: In April and May 1998, the American College of Radiology surveyed a 50% random sample of diagnostic radiology residency directors about the employment situation of their 1998 residency and fellowship graduates and about their programs. Ninety-one percent of those surveyed responded. We compared findings from the 1998 survey with similar findings from the 1997 survey, with a p value less than or equal to .05 representing statistical significance. RESULTS: Similar to 1997, 96% of residency graduates and 89% of fellowship graduates had commitments for posttraining jobs or fellowships as of the survey date. Approximately 92% of graduates had positions that directors believed reasonably matched their training and personal employment goals. The percentage of fellows with positions was similar across subspecialty fields. Completed plus planned changes in program size for residents would gradually lead to a 21 % reduction in the annual number of graduates within the next 4 years. Much as in previous years, by late April to mid May 1998, 94% of beginning-year residency slots were filled. Residency program directors were more optimistic in 1998 about graduates' job prospects than in the previous 3 years. CONCLUSION: In past years, unemployment of graduates was less than 1% by 6 months after graduation, and that is the likely outcome for 1998 graduates. Employment prospects across all subspecialty areas are approximately equal.

The situation of radiation oncology training programs and their graduates in 1997.

PURPOSE: In light of concerns about the job market, the American College of Radiology (ACR) studied the employment situation of 1997 radiation oncology graduates, and the status and plans of radiation oncology training programs. METHODS AND MATERIALS: In April-May 1997, and in a December follow-up, the ACR surveyed all radiation oncology residency directors about the employment situation of their 1997 residency and fellowship graduates and about their programs. Ninety-four percent of those surveyed responded. We compared findings with surveys from 1995 and 1996. Differences were assessed with p < or = 0.05 as the test of statistical significance. RESULTS: By six months after graduation, 98% of residency graduates and all fellowship graduates were employed. Program directors reported approximately 95% of graduates had positions that reasonably matched their training and personal employment goals. Programs have reduced beginning residency slots by 22% over the past three years, and further reductions are planned. Many observers were disappointed with fill rates in the 1997 National Match, but by the December follow-up, 96% of beginning-year residency slots were filled. CONCLUSION: Unemployment continues to be low, and one "softer" indicator, the job market perceptions of residency program directors, showed improvement.

The situation of diagnostic radiology training programs and their graduates in 1997.

OBJECTIVE: In light of concerns about the job market, the American College of Radiology studied the employment situation of 1997 graduates from diagnostic radiology training programs and the status and plans of these programs. MATERIALS AND METHODS: In an April-May 1997 survey and in a December 1997 follow-up, the American College of Radiology asked a 50% random sample of diagnostic radiology residency directors about their programs and about the employment situation of their 1997 residency and fellowship graduates. Of those surveyed, 89% responded. We compared these findings with those from a similar 1996 survey. The test of statistical significance was p < or = .05. RESULTS: All diagnostic residency and fellowship graduates who wanted to work were employed within 6 months after graduation. Approximately 95% of graduates had positions that directors believed to reasonably match their training and personal employment goals. Outcomes were similar across all fellowship fields except nuclear medicine, a field in which graduates had greater difficulty finding jobs. The completed plus planned changes in program size will lead to a 13-14% reduction in the annual number of graduates. As in previous years, by late April to mid May 1997, 93% of beginning-year residency slots were filled. However, the percentage of beginning residents who are international medical graduates increased. In 1997, residency program directors were more optimistic about graduates' job prospects than in 1996, and there was a statistically significant increase from 1996 in the proportion of fellowship graduates, according to directors, who had found jobs that fit their goals and training. CONCLUSION: Unemployment continues to be low. The 1997 job market has improved over the 1996 job market, but job prospects in nuclear medicine continue to be more problematic than in other subspecialties.

The employment market for 1995 graduates of diagnostic radiology and radiation oncology training.

OBJECTIVE: Despite widespread concern that a major surplus of non-primary-care physicians is developing, little nonanecdotal information has been available. Therefore, we developed and applied a methodology for appraising the situation of new graduates. Graduates should be particularly vulnerable because, unlike seasoned physicians. they all must find employment. MATERIALS AND METHODS: In April-May 1995, and in a December follow-up, we surveyed diagnostic radiology and radiation oncology training program directors about the status of their 1995 residency and fellowship graduates, their programs, and the employment market. More than 90% responded. We compared findings with similar 1994 surveys. Differences were assessed with t tests or multiple regression analyses, with a p value of less than or equal to .05 as the test of significance. RESULTS: Directors reported unemployment 6 months after graduation was 0.6% (+/- 0.3%) for diagnostic radiology fellows and less for others. They said approximately 90% of graduates had positions reasonably matching their training and personal employment goals. Reported unemployment rates and percentages of graduates in desired positions did not differ from 1994. However, training directors generally were more pessimistic in 1995, overwhelmingly reporting the employment market was more difficult than in recent years. Few statistically significant differences among subgroups--including diagnostic subspecialties--were found. Net planned changes in program size will generate reductions of at most a few percent in the annual number of graduates, and more than 98% of beginning year residency slots were filled. CONCLUSION: Unemployment was remarkably low. Also, surprisingly, even "soft" indicators such as undesired positions or difficulties during the process of employment search (i.e., in April-May) did not show deterioration. Projections of pending physician surpluses may be exaggerated. Given our findings, program directors' growing pessimism is puzzling. This pessimism has not called forth sizable cuts in program size and, if major surpluses are pending, neither reductions in program size nor failure to fill all available slots offer significant relief, at least to date. The employment market is about equally good (or equally difficult) across diagnostic subspecialties. The absence of regional differences indicates graduates are effectively reaching beyond the locality where they trained in their employment search.