Generalist versus Subspecialist Workforce Characteristics of Invasive Procedures Performed by Radiologists.

Purpose To explore subspecialty workforce considerations surrounding invasive procedures performed by radiologists. Materials and Methods The 2015 Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File was used to identify all invasive procedures (Current Procedural Terminology code range, 10000-69999) billed by radiologists for Medicare fee-for-service beneficiaries. Radiologists were categorized by subspecialty according to the majority of their billable work-relative value units (wRVUs). Those without a single subspecialty majority work effort were deemed generalists. Procedures were categorized into three tiers of complexity (high, ≥4.0 wRVUs; mid, 1.6-3.9 wRVUs; low, ≤1.5 wRVUs). Total and tiered generalist versus subspecialist workforce composition was assessed. Results Just 25 unique services comprised more than 75% of invasive procedures performed by radiologists. Of radiologists who performed procedures, 57.5% were generalists, 15.8% were interventionalists, and 26.8% were other subspecialists. Of the radiologists who performed low-, mid-, and high-complexity procedures, generalists accounted for 46.3%, 30.9%, and 23.1%, respectively; interventionalists accounted for 35.4%, 30.9%, and 75.2%, respectively; and other subspecialists accounted for 18.3%, 14.6%, and 1.7%, respectively. Generalists were the dominant providers of six of the top 10 low-complexity and seven of the top 10 midcomplexity procedures. Interventionalists were the dominant providers of all top 10 high-complexity procedures. Nationally, over twice as many U.S. counties had local access to generalists (869 counties) for invasive procedures versus interventionalists (347 counties) or other subspecialists (380 counties). Conclusion Among radiologists, generalists perform far more procedures in more geographic locations and are more likely to serve patients with less complex service needs than are interventionalists or other subspecialists. Practices and professional societies must remain vigilant to ensure that the subspecialty evolution in radiology does not exacerbate patient access disparities. © RSNA, 2018 Online supplemental material is available for this article.

Unifying the Silos of Subspecialized Radiology: The Essential Role of the General Radiologist.

As radiology becomes increasingly subspecialized, conversations focus on whether the general radiologist is trending toward extinction. Current data indicate that the vast majority of graduating radiology residents now seek fellowship training. Practicing entirely within the narrow confines of one's fellowship subspecialty area, however, is uncommon, with recent data indicating that more than half of all radiologists spend the majority of their work effort as generalists. From the traditional concept of the generalist as the non-fellowship-trained radiologist who interprets everything to the multispecialty-trained radiologist to the emergency radiologist who is a subspecialist but reads across the traditional anatomic divisions, the general radiologist of today and the future is one who remains broadly skilled and equipped to provide a wide spectrum of radiologic services. The successful future of many practices of all types and the specialty as a whole will require ongoing collaborative partnerships that include both general and subspecialized radiologists. This review article highlights various scenarios in which general radiologists provide value to different types of radiology practices.

Positive Impact of an Aortic Center Designation.

BACKGROUND: In January 2015, we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, Interventional Radiology, Anesthesia and Hospital Administration. We report the initial success of creating a Comprehensive Aortic Center. METHODS: All aortic procedures performed from January 1, 2015 until December 31, 2016 were entered into a prospectively collected database and compared with available data for 2014. Primary outcomes included the number of all aortic related procedures, transfer acceptance rate, transfer time, and proportion of elective/emergent referrals. RESULTS: The Aortic Center included 5 vascular surgeons, 2 cardiac surgeons, and 2 interventional radiologists. Workflow processes were implemented to streamline patient transfers as well as physician and operating room notification. Total aortic volume increased significantly from 162 to 261 patients. This reflected an overall 59% (P = 0.0167) increase in all aorta-related procedures. We had a 65% overall increase in transfer requests with 156% increase in acceptance of referrals and 136% drop in transfer denials (P < 0.0001). Emergent abdominal aortic cases accounted for 17% (n = 45) of our total aortic volume in 2015. The average transfer time from request to arrival decreased from 515 to 352 min, although this change was not statistically significant. We did see a significant increase in the use of air-transfers for aortic patients (P = 0.0041). Factorial analysis showed that time for transfer was affected only by air-transfer use, regardless of the year the patient was transferred. Transfer volume and volume of aortic related procedures remained stable in 2016. CONCLUSIONS: Designation as a comprehensive Aortic Center with implementation of strategic workflow systems and a culture of "no refusal of transfers" resulted in a significant increase in aortic volume for both emergent and elective aortic cases. Case volumes increased for all specialties involved in the center. Improvements in transfer center and emergency medical services communication demonstrated a trend toward more efficient transfer times. These increases and improvements were sustainable for 2 years after this designation.

Generalist versus Subspecialist Characteristics of the U.S. Radiologist Workforce.

Purpose To assess subspecialty practice characteristics of the U.S. radiologist workforce. Materials and Methods This study used the Medicare Physician and Other Supplier Public Use File and did not constitute human subject research. The authors identified 33 090 radiologists who billed for professional services between 2012 and 2014 and used a validated classification system to map services to seven subspecialties and quantify subspecialty-focused effort on the basis of work relative value units (RVUs). Radiologists with more than half of their billed work RVUs in a single subspecialty were designated subspecialists; the remainder were classified as generalists. Matching radiologists with various characteristics extracted from other publicly available data sets, associations were explored through use of analysis of variance and multivariable logistic regression. Results More than half (55.3%) of U.S. radiologists practice predominantly as generalists but dedicate on average 36.0% effort to one subspecialty. Among radiologists practicing as majority subspecialists, neuroradiologists (10.1% of all radiologists) and breast imagers (8.4%) are most common. Subspecialization is more common (P < .001) among radiologists who are female, are earlier in their career, work in larger practices, have academic affiliations, and practice in the Northeast. By subspecialty, female representation varies from 8.6% (interventional radiology) to 63.1% (breast imaging); cardiothoracic imagers were more commonly early career radiologists, and nuclear medicine physicians were later career radiologists. Subspecialization is considerably more common in larger (≥100 members) practices (63.1%). An academic affiliation is the strongest independent predictor of subspecialization (odds ratio, 3.56; 95% confidence interval: 3.30, 3.84). Conclusion Despite an increased focus on radiology subspecialization, most U.S. radiologists are majority general radiologists on the basis of their work RVUs. Subspecialization is by far more prevalent in larger and academic practices. © RSNA, 2017 Online supplemental material is available for this article.

Who will be the Radiologists of Tomorrow? A survey of radiology during the "Practical Year" in Germany.

Purpose Aim of our study was to evaluate the motivation of medical students in their final year of medical school to choose radiology for further specialization by means of a Germany-wide survey. Materials and Methods The survey was performed during the 2015/16 semester among German medical students in their four months radiology elective during the final year. Invitations for the study were distributed by the Student Secretariats of each university. The survey was web-based with EvaSys 7.0 software. Questions on radiology contents during medical studies and "practical year" were part of the survey. Plans for residency and possible advantages and disadvantages of radiology as medical specialty were inquired. Descriptive statistics and group comparisons were used as analysis methods. Results 89 students participated in the survey at the beginning and 60 students at the end of the practical year. Of these 39 students could be identified who answered both questionnaires. Most students were satisfied with their final year radiology elective (mean 1.8 on a range from 1 to 5). Nevertheless, they criticized mentoring during routine work (mean 2.1) and a lack of educational courses (mean 2.1). Most students (83 %) were uncertain about their residency choice at the beginning of their "practical year" and about one fifth changed their plans. From the students' point of view main advantages of radiology included contact with many other clinical disciplines (87 %) and the working conditions (68 %). The reduced patient contact (42 %), the large amount of work at a computer (43 %), and the dependency on referring physicians (42 %) were regarded as the main disadvantages. The students regarded the way radiology is taught during the studies as not practical enough. With regard to radiology the majority of students (63 %) felt poorly prepared for their future work. Conclusion The "practical year" is important regarding the choice of future specialization. There was a high degree of satisfaction with the "practical year" in radiology. The mentoring during routine work and a lack of educational courses was mildly criticized. These factors provide room for improvement to foster students' interest in radiology. Key Points · The "practical year" is important regarding the choice of further specialization.. · Criticisms of radiology in the "practical year" were mentoring and courses.. · Students feel poorly prepared for their future work regarding practical radiological skills.. Citation Format · Dettmer S, Fischer V, Paeßens C et al. Who will be the Radiologists of Tomorrow? A survey of radiology during the "Practical Year" in Germany. Fortschr Röntgenstr 2017; 189: 967 - 976.

What Patients Think About Their Interventional Radiologists: Assessment Using a Leading Physician Ratings Website.

PURPOSE: The aim of this study was to evaluate patient satisfaction scores for interventional radiologists (IRs) across the United States using a leading physician ratings website. METHODS: The physician ratings website Healthgrades was manually queried for all 2,774 Medicare-participating self-designated IRs. All patient-reviewed IRs for whom the primary "likelihood of recommending to family and friends" field was scored were included, resulting in 781 included IRs. Physician characteristics were extracted from Medicare data sets. All available patient satisfaction scores (1 [poor] to 5 [excellent]: likelihood to recommend, ease of scheduling, office environment, staff friendliness, trust in physician's decisions, how well physician explains condition, how well physician listens and answers questions, whether physician spends appropriate time with patients) and wait times were extracted from Healthgrades. Associations among measures were explored. RESULTS: IRs' mean likelihood-to-recommend score was 4.3 ± 1.2 (median, 5.0; 64.5% received a score of 5; 10.5% received scores < 3). Mean scores ranged from 4.4 to 4.5 for office-related factors and from 4.3 to 4.5 for physician-related factors. Likelihood-to-recommend scores showed substantial correlations with office-related factors (r = 0.738 to 0.780) and physician-related factors (r = 0.918 to 0.946). Likelihood to recommend was significantly higher for IRs with shorter wait times (P < .001) but was not associated with physician gender or geographic region (P = 0.370-0.791), nor was there any correlation with physician age, years since graduation, or group practice size (r = -0.089 to 0.096). CONCLUSIONS: Satisfaction scores on a leading physician ratings website generally range from very good to excellent for US IRs. Most patients leaving reviews are likely to recommend their own IRs to friends or family members. The likelihood to recommend is strongly associated with differences in wait times.

Measuring performance in the interpretation of chest radiographs: a pilot study.

AIM: To develop a system to assess the image interpretation performance of radiologists in identifying signs of malignancy on chest radiographs. MATERIALS AND METHODS: A test set of 30 chest radiographs was chosen by an experienced radiologist consisting of 11 normal and 19 abnormal cases. The malignant cases all had biopsy-proven pathology; the normal and benign cases all had at least 2 years of imaging follow-up. Fourteen radiologists with a range of experiences were recruited. Participants individually read the test set displayed on a standard reporting workstation, with their findings entered directly into a laptop running specially designed reporting software. For each case, relevant clinical information was given and the reader was asked to mark any perceived abnormality and rate their level of suspicion on a five-point scale (normal, benign, indeterminate, suspicious, or malignant). On completion, participants were given instant feedback with performance parameters including sensitivity and specificity automatically calculated. An opportunity was then given to review the cases together with an expert opinion and pathology. The time each participant took to complete the test was recorded. RESULTS: Six consultant radiologists who took part showed significantly better performance as determined by receiver operating characteristic (ROC) analysis compared to eight specialist registrars (area under the ROC curve [AUC]=0.9297 and 0.7648 respectively, p=0.003). There was a significant correlation with years of experience in the interpretation of chest radiographs and performance on the test set (r=0.573, p=0.032). Consultant radiologists completed the test significantly more quickly that the specialist registrars: mean time 19.65 minutes compared to 26.51 minutes (p=0.033). CONCLUSION: It is possible to use a test set to measure individual differences in the interpretation of chest radiographs. This has the potential to be a useful tool in performance testing.

JOURNAL CLUB: Radiologists' Online Identities: What Patients Find When They Search Radiologists by Name.

OBJECTIVE: Patients are increasingly seeking online information regarding their health and their health care providers. Concurrently, more patients are accessing their electronic medical records, including their radiology reports, via online portals. Thus, this study aims to characterize what patients find when they search for radiologists online. MATERIALS AND METHODS: All Medicare-participating U.S. radiologists were identified using the Physician Compare National Downloadable File dataset obtained from the Centers for Medicare & Medicaid Services (CMS). Using a custom application, the top 10 Google search results for each radiologist in the national dataset were retrieved, and 90.5% of website domains with more than one occurrence were categorized as follows: physician or institution controlled, third party-controlled physician information systems, social media, or other. Aggregate and subgroup analyses were performed. RESULTS: Of all U.S. health care providers recognized by CMS, 30,601 self-identified as radiologists. There was at least one search result for 30,600 radiologists (99.997%), for a total of 305,795 websites. Of all the domains, 69.8% were third party-controlled physician information systems, 17.7% were physician or institution controlled, 1.0% were social media platforms, 2.1% were other, and 9.5% were not classified. Nine of the top 10 most commonly encountered domains were commercially controlled third-party physician information systems. CONCLUSION: Most U.S. radiologists lack self-controlled online content within the first page of Google search results. Opportunities exist for individual radiologists, radiology groups, academic departments, and professional societies to amend their online presence, control the content patients discover, and improve the visibility of the field at large.