Why Medicare Advantage Plans Pay hospitals traditional Medicare prices.

The policy community generally has assumed Medicare Advantage (MA) plans negotiate hospital payment rates similar to those for commercial insurance products and well above those in traditional Medicare. After surveying senior hospital and health plan executives, we found, however, that MA plans nominally pay only 100-105 percent of traditional Medicare rates and, in real economic terms, possibly less. Respondents broadly identified three primary reasons for near-payment equivalence: statutory and regulatory provisions that limit out-of-network payments to traditional Medicare rates, de facto budget constraints that MA plans face because of the need to compete with traditional Medicare and other MA plans, and a market equilibrium that permits relatively lower MA rates as long as commercial rates remain well above the traditional Medicare rates. We explored a number of policy implications not only for the MA program but also for the problem of high and variable hospital prices in commercial insurance markets.

Clarifying the relationship between nonradiologists' financial interest in imaging and their utilization of imaging.

OBJECTIVE: Several limitations and deficiencies have been identified in existing studies of physician financial interest in imaging that show financial interest is associated with more imaging. We conducted extensive quantitative analysis of seven deficiencies that have been identified. MATERIALS AND METHODS: Using Symmetry's Episode Grouper, we created episodes of care from all the 2004-2007 health care claims for a random 5% sample of Medicare fee-for-service beneficiaries. We compared utilization of imaging in nonhospital episodes having a nonradiologist physician who had a financial interest in imaging with utilization in episodes with no such physician. We studied 23 combinations of medical conditions with imaging modalities commonly used for these conditions. RESULTS: Across four different definitions of financial interest and the 23 combinations, the relative probability (risk ratio) of imaging was uniformly higher for episodes of physicians with a financial interest, predominantly at p < 0.001. The mean relative probability was 1.87. This mean was little affected by the definition of financial interest used or the definition of the physician deemed responsible for the imaging. Controlling for patient characteristics, illness severity, and physician specialty likewise had little effect. Physicians who had acquired a financial interest averaged a 49% increase in the odds of imaging relative to physicians who had not. Physicians with a financial interest in an imaging modality used other modalities more than did physicians without a financial interest in the index modality. The Deficit Reduction Act's 2007 payment reductions had little effect. CONCLUSION: A financial interest in imaging is associated with higher utilization, probably causally. Limiting nonradiologists' financial interest in imaging may be desirable.

Trends in utilization rates of the various imaging modalities in emergency departments: nationwide Medicare data from 2000 to 2008.

PURPOSE: To study utilization trends in the various imaging modalities in emergency departments (EDs) over a recent multiyear period. METHODS: The nationwide Medicare Part B databases for 2000 to 2008 were queried. Medicare's location codes were used to identify imaging examinations done on ED patients. All diagnostic imaging Current Procedural Terminology(®) codes were grouped by modality. For each code, the database provides procedure volume; utilization rates per 1,000 beneficiaries were then calculated. Medicare's physician specialty codes were used to determine provider specialty. Utilization trends were studied between 2000 and 2008. RESULTS: The overall utilization rate per 1,000 beneficiaries for all imaging in EDs increased from 281.0 in 2000 to 450.4 in 2008 (+60%). The radiography utilization rate rose from 227.3 in 2000 to 294.3 in 2008 (+29%, 67 accrued new studies per 1,000). The CT rate rose from 40.0 in 2000 to 130.7 in 2008 (+227%, 90.7 accrued new studies per 1,000). The ultrasound rate rose from 9.6 in 2000 to 18.7 in 2008 (+95%, 9.1 accrued new studies per 1,000). Other modalities had much lower utilization. In 2000, CT constituted 14% of all ED imaging, but by 2008, it constituted 29%. In 2008, radiologists performed 96% of all ED imaging examinations. CONCLUSIONS: The rate of utilization of imaging is increasing in EDs. Growth is by far the most pronounced in CT, in terms of both the growth rate itself and the actual number of accrued new studies per 1,000 beneficiaries. Radiologists strongly predominate as the physicians of record for all ED imaging.

Physician self-referral for imaging and the cost of chronic care for Medicare beneficiaries.

BACKGROUND: As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship between self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. OBJECTIVE: To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. RESEARCH DESIGN: Using Medicare's 5% Research Identifiable Files for 2004 to 2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and total episode cost, episode imaging cost, and episode nonimaging cost. Analyses were controlled for patient characteristics (eg, age and general health status), the condition's severity, and treating physician specialty. RESULTS: Self-referral in imaging was significantly (P < 0.01) associated with total episode costs in 41 of the 76 medical condition and imaging modality (computed tomography, magnetic resonance imaging, etc.) combinations studied. Total costs were higher in 38 combinations and lower in 3. Even nonimaging costs were much more often significantly higher (in 24 combinations) with self-referral than being lower (in 4 combinations). CONCLUSIONS: We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs.

Medicare payments for noninvasive diagnostic imaging are now higher to nonradiologist physicians than to radiologists.

PURPOSE: Radiologists have always been considered the physicians who "control" noninvasive diagnostic imaging (NDI) and are primarily responsible for its growth. Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging. The purpose of this study was to track overall Medicare payments to radiologists and nonradiologist physicians in recent years. METHODS: The Medicare Part B files covering all fee-for-service physician payments for 1998 to 2008 were the data source. All codes for discretionary NDI were selected. Procedures mandated by the patient's clinical condition (eg, supervision and interpretation codes for interventional procedures, radiation therapy planning) were excluded, as were nonimaging radionuclide tests. Medicare physician specialty codes were used to identify radiologists and nonradiologists. Payments in all places of service were included. Overall Medicare NDI payments to radiologists and nonradiologist physicians from 1998 through 2008 were compared. A separate analysis of NDI payments to cardiologists was conducted, because next to radiologists, they are the highest users of imaging. RESULTS: In 1998, overall Part B payments to radiologists for discretionary NDI were $2.563 billion, compared with $2.020 billion to nonradiologists (ie, radiologists' payments were 27% higher). From 1998 to 2006, payments to nonradiologists increased by 166%, compared with 107% to radiologists. By 2006, payments to nonradiologists exceeded those to radiologists. By 2008, the second year after implementation of the Deficit Reduction Act, payments to radiologists had dropped by 13%, compared with 11% to nonradiologists. In 2008, nonradiologists received $4.807 billion for discretionary NDI, and radiologists received $4.638 billion. Payments to cardiologists for NDI increased by 195% from 1998 to 2006, then dropped by 8% by 2008. CONCLUSIONS: The growth in fee-for-service payments to nonradiologists for NDI was considerably more rapid than the growth for radiologists between 1998 and 2006. Then, by the end of 2008, 2 years after the implementation of the Deficit Reduction Act, steeper revenue losses had been experienced by radiologists. The result was that by 2008, overall Medicare fee-for-service payments for NDI were 4% higher to nonradiologists than they were to radiologists.

Bending the curve: the recent marked slowdown in growth of noninvasive diagnostic imaging.

OBJECTIVE: The purpose of this article is to determine whether there has been any change in the rapid growth pattern that has characterized noninvasive diagnostic imaging in recent years. MATERIALS AND METHODS: The annual nationwide Medicare Part B databases were used. All Current Procedural Terminology codes for discretionary noninvasive diagnostic imaging were identified. The overall utilization rates per 1,000 fee-for-service beneficiaries were calculated from 1998 through 2008, as were rates by modality. Determination was made as to whether studies were interpreted by radiologists or nonradiologist physicians. RESULTS: The total utilization rate of noninvasive diagnostic imaging grew at a compound annual growth rate of 4.1% from 1998 to 2005, but this decreased to 1.4% from 2005 to 2008. From 2005 through 2008, the overall growth trends flattened dramatically for MRI and nuclear medicine and abated somewhat for CT, ultrasound, and echocardiography. In ambulatory settings, flattening of the advanced imaging growth curves was seen in both private offices and hospital outpatient facilities. From 1998 to 2005, the compound annual growth rate was 3.4% among radiologists and 6.6% among nonradiologist physicians. From 2005 to 2008, the compound annual growth rate decreased to 0.8% among radiologists and 1.8% among nonradiologists. CONCLUSION: There has been a distinct slowing in the growth of discretionary noninvasive diagnostic imaging in the Medicare fee-for-service population since 2005. The slowdown has been most pronounced in MRI and nuclear medicine. This should allay some of the concerns of policymakers and payers. Both before and after 2005, growth was approximately twice as rapid among nonradiologist physicians as among radiologists.

Imaging self-referral associated with higher costs and limited impact on duration of illness.

Self-referral for imaging services occurs when a physician sends patients to receive an imaging procedure from a device that the physician owns or leases. Advocates argue that this shortens the duration of illness and lowers costs. For twenty common combinations of medical conditions and types of imaging, we evaluated the association between self-referral, duration of illness episode, and three measures of cost. Self-referral was associated with significantly and substantially higher episode costs for most of the combinations of medical conditions and imaging that we studied. There was no decrease in the length of illness, except when doctors self-referred patients to receive x-rays for a few common conditions. These findings indicate that except for x-rays, constraining the self-referral of imaging may be appropriate.

The performance of outside readings by radiology practices.

OBJECTIVE: The purpose of our study was to determine how many radiology practices perform outside readings, what characteristics affect the prevalence and volume of outside readings, and how practices are paid for outside readings. MATERIALS AND METHODS: We analyzed data from the American College of Radiology's 2007 Survey of Radiologists, a stratified random sample e-mail and telephone survey. A total of 480 survey responses were evaluated; responses were weighted to make them representative of all U.S. radiology practices. We provide descriptive statistics and multivariable regression analysis results. RESULTS: Overall, 40% of radiology practices in the United States performed outside readings in 2007. Outside readings constituted an average of 11% of the workload of these practices and 4% of the total workload of radiologists in the United States. Other practice characteristics being equal, academic practices, government practices, radiology units of multispecialty groups, and small practices had particularly low odds of performing outside readings. If they did perform outside readings, then, other practice characteristics being equal, small practices, solo practices, radiology units of multispecialty groups, practices in the main cities of large metropolitan areas, and those in nonmetropolitan areas had, on average, a relatively large portion of their workload consisting of outside readings. By far, the most common methods of payment were directly billing for the professional component or receiving a flat fee per study. CONCLUSION: Outside readings were a common activity among radiology practices in 2007. There was substantial variability among practice types, sizes, and locations in whether practices performed outside readings and, if so, how much outside reading they did.

How widely is computer-aided detection used in screening and diagnostic mammography?

PURPOSE: The aim of this study was to determine how widely computer-aided detection (CAD) is used in screening and diagnostic mammography and to see if there are differences between hospital facilities and private offices. METHODS: The nationwide Medicare Part B fee-for-service databases for 2004 to 2008 were used. The Current Procedural Terminology(®) codes for screening and diagnostic mammography (both digital and screen film) and the CAD add-on codes were selected. Procedure volume was compared for screening vs diagnostic mammography and for hospital facilities vs private offices. RESULTS: From 2004 to 2008, Medicare screening mammography volume increased slightly from 5,728,419 to 5,827,326 (+2%), but the use of screening CAD increased from 2,257,434 to 4,305,595 (+91%). By 2008, CAD was used in 74% of all screening mammographic studies. During this same time period, the Medicare volume of diagnostic mammography declined slightly from 1,835,700 to 1,682,026 (-8%), but the use of diagnostic CAD increased from 360,483 to 845,461 (+135%). By 2008, CAD was used in 50% of all diagnostic mammographic studies. In hospital facilities in 2008, CAD was used in 70% of all screening mammographic studies, compared with 81% in private offices. For diagnostic mammography in 2008, CAD was used in 48% in hospitals, compared with 55% in private offices. CONCLUSION: Despite some operational drawbacks to using CAD, radiologists have embraced it in an effort to improve cancer detection. Its use has grown rapidly, and in 2008, it was used in three-quarters of all screening mammographic studies and half of all diagnostic mammographic studies. Women undergoing either screening or diagnostic mammography are more likely to receive CAD if they go to a private office than if they go to a hospital facility, although the differences are not great.

Effect of advanced imaging technology on how biopsies are done and who does them.

PURPOSE: To assess national levels and trends in utilization of biopsy procedures during the past decade and investigate the relative roles of biopsy approaches (open, endoscopic, and percutaneous) and physician specialties. MATERIALS AND METHODS: Institutional review board approval was not necessary because only public domain data were used. Aggregated Medicare claims data were used to determine utilization of biopsies performed in 10 anatomic regions from 1997 to 2008. Utilization levels according to biopsy approach and anatomic region were calculated. Trends in the relative utilization of percutaneous needle biopsy (PNB) and imaging-guided percutaneous biopsy (IGPB) were assessed. The relative roles of radiologists and nonradiologists in the performance of all biopsies, PNBs, and IGPBs were evaluated. RESULTS: Biopsy procedures with all approaches increased from 1380 to 1945 biopsies per 100,000 Medicare enrollees between 1997 and 2008, which represents a compound annual growth rate (CAGR) of 3%. Utilization of non-PNBs fell, while the absolute level and relative share of PNBs increased. In 2008, 67% of all biopsies were performed by using a percutaneous route. IGPB as a percentage of all PNBs increased over time in the regions for which data were available. Radiology was the leading specialty providing biopsy services. The total number of biopsies performed by radiologists increased at a CAGR of 8%, and radiologists' share of all biopsies increased from 35% to 56%. CONCLUSION: During the past decade, there was continuing substitution away from invasive approaches and non-imaging-guided percutaneous approaches in favor of PNBs and IGPBs, likely related to increasing use of advanced imaging modalities for biopsy guidance. Consequently, radiologists are performing an increasing share of biopsies across all anatomic regions.

Utilization of interventional oncology treatments in the United States.

PURPOSE: To report on the recent national trends in utilization of interventional oncology (IO) treatments, assess the use of these techniques relative to the utilization of alternative oncologic treatments, and provide an assessment of which specialties are providing these services. MATERIALS AND METHODS: The Centers for Medicare and Medicaid Services Physicians/Supplier Procedure Summary Master Files from 2002 through 2008 and Limited Data Set Standard Analytical Files from 2002 through 2007 were used to determine utilization rates of ablative therapies and transarterial embolizations for malignant neoplasms and comparable surgical procedures. RESULTS: In 2008, 10,045 IO treatments were performed in the Medicare population, or 29 per 100,000 Medicare enrollees. IO treatments of the liver constituted the largest component, at 64%, followed by the kidneys at 23%. Over a period of 6 years, growth was seen in all IO procedures except for transarterial embolizations for renal tumors. Radiologists performed 91% of all IO procedures in 2008. CONCLUSIONS: IO utilization is modest in volume, but growing. IO treatments comprised the majority of oncologic treatments in the liver but only a small part of treatments in the kidneys and lungs. Radiologists are currently providing the vast majority of IO treatments.

Frequency of use of imaging tests in the diagnosis of pulmonary embolism: effects of physician specialty, patient characteristics, and region.

OBJECTIVE: The purpose of this study was to ascertain whether clinical practice in diagnosing pulmonary embolism is consistent with recommendations in the literature and to explore variations in practice across site of care (e.g., emergency department), physician and patient characteristics, and geographic location. MATERIALS AND METHODS: Medicare 5% research identifiable files were analyzed. The cases of patients with emergency department visits or inpatient stays for a diagnosis of pulmonary embolism or for symptoms related to pulmonary embolism (shortness of breath, chest pain, and syncope) were identified. We determined the number of patients who underwent each type of relevant imaging test and evaluated variations in the first non-chest-radiographic test by site of care and treating physician specialty. Using logistic regression, we studied variations in the use of common imaging tests, exploring variations associated with patient characteristics, physician specialty, site of care, and geographic location. RESULTS: For patients in whom pulmonary embolism might have been suspected, the most common tests were echocardiography (26% of the patients), CT or CT angiography of the chest (11%), cardiac perfusion study (6.9%), and duplex ultrasound (7.3%). For patients with an inpatient diagnosis of pulmonary embolism, the most common tests were chest CT or CT angiography (49%), duplex ultrasound (18%), echocardiography (10.9%), and ventilation-perfusion scintigraphy (10.9%). For patients for whom pulmonary embolism might have been suspected, many large variations were found in practice patterns among physician specialties and geographic locations. There were fewer variations among patients with the inpatient diagnosis of pulmonary embolism. CONCLUSION: Physician practice in the diagnosis of pulmonary embolism is broadly consistent with recommendations. However, variations by physician specialty and geographic location may be evidence of inappropriate imaging.

Who's underworked and who's overworked now? An update on radiologist shortage and surplus.

OBJECTIVE: The purpose of this study was to present an updated report on the radiologist surplus and shortage situation using a recently developed improved measure-namely, the extent to which radiologists desire less or more work if their income were to change by the same percentage as their workload. MATERIALS AND METHODS: Non-individually identifiable data from the American College of Radiology's (ACR's) 2007 Survey of Diagnostic Radiologists were used. Responses were weighted to be representative of all posttraining professionally active radiologists in the United States. Information is presented for all radiologists and according to such factors as type and size of practice, radiologist subspecialty, and geographic region. Multivariable regression analysis was used to identify the probable causal links between desired workload change and characteristics of radiologists and the practices where they work. Comparisons were made with ACR's similar 2003 Survey of Radiologists. RESULTS: The net average workload change sought in 2007 was an approximately 3% increase. In 2003, radiologists on average did not desire a statistically significant change in workload. Regression analysis for 2007 showed a pattern of relative shortages and surpluses that was generally, but not entirely, different from that found in 2003. CONCLUSION: The overall balance between the demand and the supply of radiologists shifted toward a surplus between 2003 and 2007. According to our measure, we judge there was a close balance in 2003, but a 3% surplus in 2007. The employment market seems generally, but not universally, to self-correct relative shortages and surpluses in individual geographic areas and subspecialties within a few years.

What factors affect the productivity and efficiency of physician practices?

BACKGROUND: Increasing the productivity and efficiency of physician practices could help relieve the rapid growth of US healthcare costs and the expected physician shortage. Radiology practices are an attractive specific focus for research on practices' productivity and efficiency because they are home to many purportedly productivity-enhancing operational technologies. This affords an opportunity to study the effect of production technology on physicians' output. As well, radiology is a leader in the general movement of physicians out of very small practices. And imaging is by the fastest-growing category of physician expenditure. RESEARCH DESIGN: Using data from 2003 to 2007 surveys of radiologists, we estimate a stochastic frontier model to study the effects of practice characteristics, such as work hours, practice size, and output mix, and technologies used in work production, on practices' productivity and efficiency. RESULTS: At the mean, the elasticities of output with respect to practice size and annual hours worked per full-time physician were 0.73 and 0.51, respectively. Some production technologies increase productivity by 15% to 20%; others generate no increase. Using "nighthawks"--ie, contracting out after-hours work to external firms that consolidate workflow--significantly increases practice efficiency. CONCLUSIONS: The general US trend toward larger practice size is unlikely to relieve cost or physician shortage pressures. The actual effect of purportedly productivity-enhancing operational technologies needs to be carefully evaluated before they are widely adopted. As the recently-developed innovations of nighthawks and hospitalists show, practices should give more attention to a possible choice to "buy," rather than "make," part of their output.

Imaging evaluation for suspected pulmonary embolism: what do emergency physicians and radiologists say?

OBJECTIVE: The utility of various imaging techniques and strategies for the diagnosis of pulmonary embolism has been studied in randomized control trials and extensively described in the literature. CT and ventilation-perfusion scintigraphy are the mainstays of diagnosis, and MRI is emerging. The purpose of this study was to assess the diagnostic approach to pulmonary embolism practiced by emergency physicians and advised by radiologists. MATERIALS AND METHODS: Questionnaires were sent to emergency physicians and radiologists in Pennsylvania. The questions covered diagnostic strategies for the detection of pulmonary embolism in the usual situations and in clinical circumstances in which the primary imaging technique is considered less desirable. RESULTS: Sixty-two radiologists and 52 emergency physicians completed the survey. Ninety percent of radiologists and 96% of emergency physicians answered that CT was their first-line choice for the diagnosis of pulmonary embolism. The use of ventilation-perfusion scintigraphy increased in the care of patients with renal failure and allergy to iodinated contrast material. MRI was chosen infrequently. CONCLUSION: CT is the overwhelmingly preferred technique for the diagnosis of pulmonary embolism. The role of ventilation-perfusion scintigraphy increases when the use of iodinated contrast material is contraindicated. MRI does not seem to have an important role in practice.

The actual role of CT and ventilation-perfusion scanning in workup for suspected pulmonary embolism: evidence from hospitals.

OBJECTIVE: Over the past two decades, CT has been found valuable in the diagnosis of pulmonary embolism (PE). We sought to ascertain the relative roles of CT and ventilation-perfusion (V/Q) scanning, the previously preferred technique, in the diagnosis of PE in recent practice and whether there is variation among hospital types. MATERIALS AND METHODS: Using the Medicare anonymized 5% of beneficiaries complete claims file for 2005, we studied the use of relevant CT and V/Q scanning in the evaluation of patients with a diagnosis of PE and of patients with symptoms that might have been due to PE (chest pain, syncope, difficulty breathing). In 2008, we surveyed the radiology departments of Pennsylvania hospitals about the use of CT and V/Q scanning for PE, service availability hours, and what equipment was used. RESULTS: In all data, we found that CT was used approximately six times as frequently as V/Q scanning. In the Medicare data, only small differences in frequency of use of CT and V/Q scanning were associated with hospital characteristics. Academic hospitals did not differ in a major way from other hospitals, nor did small or rural hospitals. In the survey, 97% of radiology departments reported that CT was available for evaluation of PE 24 hours a day 7 days a week. Ninety-three percent of departments reported V/Q scanning was available at some times; 77% reported V/Q available at all times. CONCLUSION: CT was a fully disseminated and dominant technique for the diagnosis of PE by 2005, and it was readily available at small and rural hospitals. The lack of availability of off-hours V/Q scanning at a substantial fraction of hospitals may be a problem for patients with contraindications to CT.

Radiology practices' use of external off-hours teleradiology services in 2007 and changes since 2003.

OBJECTIVE: Our objective is to report patterns of utilization of external off-hours teleradiology services (EOTSs) in 2007 and changes since 2003. MATERIALS AND METHODS: We analyzed non-individually identified data from the American College of Radiology's 2007 Survey of Member Radiologists and its 2003 Survey of Radiologists. Responses were weighted to be nationally representative of individual radiologists and radiology practices. We present descriptive statistics and multivariable regression analysis results on the use of EOTSs in 2007 and comparisons with 2003. RESULTS: Overall, 44% of all radiology practices in the United States reported using EOTSs in 2007. These practices included 45% of all U.S. radiologists. Out-of-practice teleradiology had been used by 15% of practices in 2003. Regression analysis indicates that, other practice characteristics being equal, in 2007, primarily academic practices had lower odds of using EOTSs than private radiology practices. Also, large practices (>or= 30 radiologists) had lower odds of using EOTSs than practices with 15-29 radiologists. Small practices (1-10 radiologists) had high odds, but nonmetropolitan practices did not. There were no significant differences by geographic region of the United States. CONCLUSION: Use of EOTSs was widespread by 2007, and it had been increasing rapidly in the preceding few years. Patterns of use were generally as might be expected except that nonmetropolitan practices did not have high odds of using EOTSs.

Factors influencing subspecialty choice among radiology residents: a case study of pediatric radiology.

PURPOSE: Persistent workforce shortages exist in some radiology subspecialties. Residents' motivations for selecting particular fellowships, as well as their perceptions of the subspecialty fields, heavily influence the supply of new radiologists to these areas. The authors investigated the factors residents consider most important in subspecialty choice, fellowship choice patterns between 1999 and 2008, and changes that might attract residents to one particular shortage field: pediatric radiology. MATERIALS AND METHODS: An online questionnaire was developed and sent to 1,000 radiology trainees in the United States using contact information from the ACR's national resident database. Anonymized responses were evaluated using analysis of variance and logistic regression models. RESULTS: Leading factors for fellowship selection were "area of strong personal interest," "advanced/multimodality imaging," and "intellectual challenge." Compensation ranked low, 13th among 20 factors. Large shifts in subspecialty preference were seen between 1999 and 2008. Those with a pediatric radiology preference ranked "physician-physician interaction," "physician-patient contact," and "altruism" higher than respondents selecting other subspecialties. Respondents believed that pediatric radiologists make less money than other subspecialists ($325,000 vs $385,000 per year). There was no association between choosing pediatric radiology and gender, age, research plans, or parental status. CONCLUSIONS: Multiple factors account for subspecialty selection among residents, and it is useful to understand these factors when attempting to recruit residents to specific subspecialties. To ease the workforce shortage in pediatric radiology, advanced and varied imaging modalities, numerous job opportunities, and well-paid private practice positions should be emphasized to residents.

Trends in work hours and vacation time among radiologists in the United States.

OBJECTIVE: The purpose of this study was to describe recent trends in weekly work hours and annual vacation days among full-time radiologists in the United States with separate data for academic radiologists, radiologists in multispecialty groups, and radiologists in private practice. MATERIALS AND METHODS: We tabulated non-individually identified responses from the American College of Radiology 1995, 2003, and 2007 surveys of radiologists. These stratified random sample surveys had, respectively, 2,025, 1,924, and 487 responses and response rates of 75%, 63%, and 20%. Responses were weighted to make them representative of all U.S. radiologists. Respondents were assured of confidentiality. RESULTS: Mean weekly hours worked increased from 1995 to 2003 and from 2003 to 2007. The total increase was approximately 5 hours, or 10%. Mean vacation days also increased in both subperiods, from 27 in 1995 to 39 in 2007, yielding an approximately 5% decrease in days worked per year. The overall result was a mean increase of approximately 5% in annual work hours. In 2007, the 25th percentile of weekly hours was 45, and the 75th percentile was 55. The 25th percentile of annual vacation days was 25, and the 75th percentile was 50. Full-time radiologists responding about their own weekly hours reported, at the mean, working 10% more hours than they believed was the average for other full-time radiologists in the practice. CONCLUSION: Weekly hours and annual vacation days both have increased. The percentiles give radiologists a basis for comparison with other radiologists. Radiologists apparently often overestimate their work hours relative to the hours of others in their practices. Misperceptions of this kind might give rise to friction in radiology practices.

Workload of radiologists in United States in 2006-2007 and trends since 1991-1992.

PURPOSE: To determine radiologists' workloads in 2006-2007, as measured by both procedures per full-time equivalent (FTE) radiologist and relative value units (RVUs) per FTE radiologist, and to discover trends since 1991-1992. MATERIALS AND METHODS: Non-individually identifiable data from the American College of Radiology (ACR) 2007 Survey of Radiologists were compared with data from previous ACR surveys; all surveys were weighted to make them nationally representative. Under National Institutes of Health rules for protection of human subjects, studies based on anonymized surveys do not require approval by an institutional review board. Workload according to individual practice characteristics, such as type (eg, academic, private, multispecialty) and setting, was tested for statistically significant differences from the average for all radiologists. Time trends and the independent effect on workload of practice characteristics were measured with regression analyses. Changes in average procedure complexity were calculated in physician work RVUs per Medicare procedure. RESULTS: In 2006-2007, the average annual workload per FTE radiologist was 14,900 procedures, an increase of 7% since 2002-2003 and 34.0% since 1991-1992. Annual RVUs per FTE radiologist were 10 200, an increase of 10% since 2002-2003 and 70.3% since 1991-1992. Academic practices performed about one-third fewer procedures per FTE radiologist than others. In most types of practice, radiologists in a 75th-percentile practice performed at least 65% more procedures annually than radiologists in a 25th-percentile practice. Regression analysis showed that practices that used external off-hours teleradiology services performed 27% more procedures than otherwise similar practices that did not use these services. CONCLUSION: Radiologists' workload continued to increase in recent years. Because there is much unexplained variation, averages or medians should not be used as norms. However, such statistics can help practices to understand how they compare with other, similar practices. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/2522081895/DC1.