Radiology’s Private-Practice Squeeze

It’s no secret that US radiology’s traditional private-practice model has been slowly fading away, but new numbers published in AJR illustrate the magnitude of the shift. The number of radiologist-affiliated and radiologist-only practices has dropped, even as the total number of US radiologists has gone up. 

Radiology has long prided itself on a cozy business model in which radiologists banded together as owner-operators of small private-practice groups that contracted their services with hospitals. 

  • This model has had many benefits for radiologists, but it’s begun to fray in the face of competitive threats like teleradiology providers, health system consolidation, and large national radiology groups like Radiology Partners.

Many radiologists have chosen to switch rather than fight, selling out to national groups or taking positions as employees within health systems.

  • Meanwhile, some practices that want to stay independent are finding strength in numbers by joining with other like-minded groups or seeking out multi-specialty medical groups. 

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute analyzed CMS data from 2014 to 2023, tracking not only changes in the number of US radiologists but also their type of employment, finding …

  • The number of radiologists grew 17%, from 30.7k to 36k
  • But the number of radiologist-affiliated practices fell 15%, from 5.1k to 4.3k
  • The number of radiology-only practices fell 32%
  • The number of small radiology practices fell, with the decline varying by practice size: 1-2 radiologists -19%, 3-9 radiologists -34%, and 10-24 radiologists -25%
  • The number of large practices jumped, with the biggest increase – 349% – at very large practices (over 100 radiologists)
  • The mean number of radiologists per practice shot up 84%, from 9.7 to 17.9

Why the shift? The researchers theorized that much of it was driven by federal policy and reimbursement changes that incentivize consolidation, mostly to spread the risk and cost of compliance with various regulations like ACA and MACRA.

The Takeaway

There’s no question that radiology is changing – the question is what impact the changes will have on how radiologists perceive their work. The old guard may choose to rage against the dying of the light, while younger generations embrace the new model and its benefits for both professional careers and patient care. 

Radiologist Pay Rebounds

Radiologist pay grew 5.6% and radiology moved up one notch on Doximity’s list of highest-paid US medical specialties for 2023. Physician salaries generally rebounded last year after a decline in 2022.

The Doximity survey of 33k doctors found that overall physician pay grew 5.9% last year, a welcome rebound after a decline of 2.4% in 2022. 

  • In other good news, medicine’s gender pay gap narrowed in the new survey, with women making 23% less than men, down from 26% in 2022 and 28% in 2021.

For radiologists, their average annual compensation was $532k, up from $504k a year ago, and radiology jumped ahead of urology on the top 10 list to occupy the ninth spot. 

  • Still, radiology lagged a number of other specialties in terms of salary growth, ranging from hematology (+12.4%) to psychiatry (+7.2%). 

Other findings in the survey include …

  • Some 81% of physicians reported they are overworked, a number that’s actually down from 86% in 2022
  • 88% of respondents said their clinical practice has been affected by the physician shortage
  • 86% of those surveyed said they are concerned about the US healthcare system’s ability to care for its aging population

The Doximity results roughly track recently released salary data from Medscape, which pegged radiologist salaries at $498k in 2023, up 3.1% and ranking sixth on the list of highest-paid specialties. 

The Takeaway

Say what you want about rising workload and burnout in radiology – radiologists are still among the best-compensated physicians in medicine. And the situation in the US is in sharp contrast to Japan, where radiology is one of the lowest-paid specialties (see our article in The Wire section below).

Doctors Work Harder for Less

Medicare reimbursement to physicians per beneficiary has declined over the last 16 years, with radiologists among the biggest losers. That’s according to a new study by the ACR’s Harvey L. Neiman Health Policy Institute, which confirms what many physicians already knew: they are working harder for less money.

It’s no secret that the US government has been struggling to rein in healthcare costs for decades. 

CMS has a number of tools at its disposal for controlling Medicare and Medicaid costs, one of which is the relative value unit (RVU) scale. 

  • RVUs – when multiplied by monetary conversion factors – basically set the amount of money the agency pays physicians per unit of work, with CMS typically reducing the conversion factor when it needs to cut Medicare spending. 

In the new study in the journal Inquiry, Neiman HPI researchers analyzed trends in RVU and conversion factor levels per Medicare beneficiary from 2005 to 2021, analyzing changes to calculate how much work providers have to do to deliver a unit of care. Findings included …

  • Reimbursement per Medicare beneficiary after inflation adjustment fell 2.3% for physicians as a whole
  • Radiology saw one of the biggest declines in MPFS reimbursement per beneficiary, ranking 31st on a list of 39 medical specialties, with a 25% decrease
  • Reimbursement has risen 207% for non-physician practitioners

What’s driving the declines? The Neiman HPI researchers identified the federal government’s budget neutrality rules for Medicare, which stipulate that increases in one area have to be offset by declines elsewhere.

The Takeaway

The new findings confirm what many physicians have suspected – they are not only working harder for less, but non-physician practitioners seem to be getting a bigger piece of the pie. Combined with a recent report showing that radiologist salaries didn’t keep pace with inflation in 2023, it’s not a pretty picture. 

Radiologist Pay Grows 3%

Annual salaries for US radiologists grew 3.1% in 2023 in the most recent physician salary report by Medscape. Although radiologist salaries are nearing the half-million-dollar mark, the increase actually represents a slowdown compared to 11% growth last year

The Medscape report shows that US radiologists had an average annual salary of $498k in 2023, compared to $483k in 2023 and $437k in 2022.

  • Radiologists ranked sixth on a list of 29 medical specialties, with orthopedic physicians topping the charts at $558k and diabetes and endocrinology doctors at the bottom at $256k. 

The report surveyed 7k practicing US physicians from October 2023 to January 2024, finding … 

  • 61% of those surveyed thought physicians overall are underpaid
  • 49% believe that they themselves are fairly paid
  • 83% said that pay was either no factor or only a minor factor in the specialty they chose, with only 14% saying it was the leading factor
  • Male specialists earned 31% more than female specialists, indicating a widening gender gap compared to 27% last year
  • 57% of radiologists were happy with their compensation, sixth among 29 medical specialties

Physician comments submitted to Medscape focused on the significant stress being experienced by many physicians, a phenomenon that’s been linked to burnout in other surveys. 

The Takeaway

Underlying this year’s Medscape data is an inconvenient truth for radiologists: their 3.1% pay gains for the year were not enough to keep pace with the US inflation rate of 3.4%. In that respect, radiologists find themselves in the same situation as most Americans.

MSK Problems Weigh Down Interventional Radiologists

Musculoskeletal problems are common among interventional radiologists, caused by many hours wearing heavy radiation protection gear. That’s according to a new study in European Journal of Radiology which found that almost half of interventionalists suffered from multiple orthopedic problems, issues that forced a significant portion to either reduce or stop their interventional practice. 

Interventional radiology has been responsible for major improvements in patient care through image-guided procedures that are noninvasive and can eliminate the need for open surgery, reducing patient recovery times to hours rather than days.

  • But these advances can come at the cost of higher radiation doses to the personnel who perform and assist with interventional radiology procedures, which has led to issues such as higher breast cancer rates among women who work with image-guided procedures and even DNA damage in cases of long-term exposure.

Radiation protection gear is worn by interventionalists to mitigate that radiation risk, but this gear is heavy and can carry risks of its own, which were investigated by researchers from the University Hospital Marburg in Germany. They conducted a 17-question survey of orthopedic problems among interventional radiologists, receiving 221 responses indicating that …

  • Some 48% of responders experienced more than five orthopedic problems during their interventional career
  • Problems of the lumbar spine were reported by 82% of respondents, followed by cervical spine (33%), shoulder (29%), and knee (25%)
  • Orthopedic problems caused 16% of respondents to reduce their interventional activities, and 2.7% to stop their practice altogether
  • Just 16% of respondents said they had never experienced an orthopedic problem in their career

The new findings track with previous research highlighting the toll that radiation protection gear takes on interventional personnel. The researchers said that one positive finding of their study was that all interventional radiologists reported wearing radiation protection, although fewer respondents reported using radiation glasses (49%) or visors (11%) despite radiation’s known risk of cataracts.

The Takeaway

This study indicates that interventional radiologists are caught between a rock (radiation dose) and a hard place (orthopedic problems). Relief could come from companies that are developing radiation protection solutions such as free-hanging radiation protection gear; for interventional personnel, these options can’t come soon enough.

Radiology’s Enduring Popularity

Radiology is seeing a resurgence of interest from medical students picking the specialty in the National Resident Matching Program (NRMP). While radiology’s popularity is at historically high levels, the new analysis shows how vulnerable the field is to macro-economic trends in healthcare. 

Radiology’s popularity has always ebbed and flowed. In general the field is seen as one of the more attractive medical specialties due to the perception that it combines high salaries with lifestyle advantages. But there have been times when medical students shunned radiology.

The new paper offers insights into these trends. Published in Radiology by Francis Deng, MD, and Linda Moy, MD, the paper fleshes out an earlier analysis that Deng posted as a Twitter thread after the 2023 Match, showing that diagnostic radiology saw the highest growth in applicants to medical specialties over a three-year period.

Deng and Moy analyze trends in the Match over almost 25 years in the new study, finding…

  • The 2023 Match in radiology was the most competitive since 2001 based on percentage of applicants matching (81.1% vs. 73.3%)
  • 5.9% of seniors in US MD training programs applied to diagnostic radiology in the 2023 Match, the highest level since 2010
  • Fewer radiology residency slots per applicant were available in 2023 compared to the historical average (0.67 vs. 0.81) 

Interest in radiology hit its lowest levels in 1996 and 2015, when the number of applicants fell short of available radiology residency positions in the Match. It’s perhaps no surprise that these lows followed two major seismic healthcare shifts that could have negatively affected job prospects for radiologists: the “Hillarycare” healthcare reform effort in the early 1990s and the emergence of AI for healthcare in the mid-2010s. 

Hillarycare never happened, and Deng and Moy noted that outreach efforts to medical students about AI helped reverse the perspective that the technology would be taking radiologists’ jobs. Another advantage for radiology is its early adoption of teleradiology, which enables remote work and more flexible work options – a major lifestyle perk. 

The Takeaway

The new paper provides fascinating insights that support why radiology remains one of medicine’s most attractive specialties. Radiology’s appeal could even grow, given recent studies showing that work-life balance is a major priority for today’s medical students.

Are Doctors Overpaid?

A new study on physician salaries is raising pointed questions about pay for US physicians and whether it contributes to rising healthcare costs – that is, if you believe the numbers are accurate. 

The study was released in July by the National Bureau of Economic Research (NBER), which produces in-depth reports on a variety of topics. 

The current paper is highly technical and may have languished in obscurity were it not for an August 4 article in The Washington Post that examined the findings with the claim that “doctors make more than anyone thought.”

It is indeed true that the NBER’s estimate of physician salaries seems high. The study claims US physicians made an average of $350k in 2017, the year that the researchers focused on by analyzing federal tax records. 

  • The NBER estimate is far higher than $294k in Medscape’s 2017 report on physician compensation – a 19% difference. 

The variation is even greater for diagnostic radiologists. The NBER data claim radiologists had a median annual salary in 2017 of $546k – 38% higher than the $396k average salary listed in Medscape’s 2017 report. 

  • The NBER numbers from six years ago are even higher than 2022/2023 numbers for radiologist salaries in several recent reports, by Medscape ($483k), Doximity ($504k), and Radiology Business ($482k). 

But the NBER researchers claim that by analyzing tax data rather than relying on self-reported earnings, their data are more accurate than previous studies, which they believe underestimate physician salaries by as much as 25%. 

  • They also estimate that physician salaries make up about 9% of total US healthcare costs.

What difference is it how much physicians make? The WaPo story sparked a debate with 6.1k comments so far, with many readers accusing doctors of contributing to runaway healthcare costs in the US.

  • Meanwhile, a thread in the AuntMinnie forums argued whether the NBER numbers were accurate, with some posters warning that the figures could lead to additional cuts in Medicare payments for radiologists. 

The Takeaway

Lost in the debate over the NBER report is its finding that physician pay makes up only 9% of US healthcare costs. In a medical system that’s rife with overutilization, administrative costs, and duplicated effort across fragmented healthcare networks, physician salaries should be the last target for those who actually want to cut healthcare spending. 

Salary Data Reveal Medicine’s Golden Cage

Are you a glass-half-full or a glass-half-empty kind of person? Either way, there’s lots to unpack in the latest data on physician salaries, this time from Medscape

Medscape’s survey of over 10k US physicians across over 29 medical specialties found that overall physician salaries have grown 18% over the last five years, to $352k, while specialists made an average of $382k. 

As with last year, radiologists landed in the top 10 of highest-compensated specialists, a finding that’s in line with previous salary surveys, such as from Doximity. Medscape found that radiologists had an average annual salary of $483k in 2023, compared to $437k in 2022. Radiologists had an average annual salary of $504k in the Doximity data. 

Other nuggets from the Medscape survey:

  • “Stagnant” reimbursement relative to rising practice costs has cut into physician income. 
  • The gender gap is narrowing. Male primary care doctors in 2023 earn 19% more than females, compared to about 25% previously.
  • Male specialist physicians earn 27% more than females, down from 31% last year and 33% the year before that.
  • Only 19% of radiologists are women – one of the lowest rates of female participation among medical specialties. 
  • 58% of radiologists feel they are fairly paid.
  • Radiologists report working an average of 49.6 hours a week.
  • 90% of radiologists say they would choose their specialty again, ranking #10.

The Takeaway

On the positive side, physician salaries continue to rise, and medicine is making encouraging progress in narrowing the gender gap. Radiologists seem to be well-compensated and relatively happy, but the specialty has more to do to attract women.

Underlying the raw data is a disturbing undercurrent of physician dissatisfaction, with many feeling as though medicine is a golden cage. In the free-response portion of the survey, doctors described themselves as caught between falling reimbursement and rising costs, with overwork also leading to burnout

The Medscape survey shows that addressing physician burnout must become a priority for the US healthcare system, and it can’t be solved merely by boosting salaries. Increasing the number of residency slots is a good first step (see below).

Radiology Bucks Doctor Salary Decline

The latest news on physician salaries is out, and it’s not pretty. A new Doximity survey found that average physician pay declined 2.4% last year, compared to an increase of 3.8% in 2021. The drop was exacerbated by high inflation rates that took a bite out of physician salaries. 

The Doximity report paints a picture of physicians beset by rising burnout, shortages, and a persistent gender pay gap. Doctors across multiple specialties report feeling more stressed even as wage growth has stalled.

To compile the 2022 data, Doximity got responses from 31,000 US physicians. There was a wide range of average annual compensation across medical specialties, with radiology landing at number 10 on the top 20 list, while nuclear medicine occupied the 20th spot:

  • Radiation oncology: $547k vs. $544k in 2021
  • Radiology: $504k vs. $495k 
  • Nuclear medicine: $392k vs. $399k

In other findings of the report:

  • Male physicians made $110,000 more than women doctors. At a gap of 26%, this is actually an improvement compared to 28% in 2021.
  • Men physicians over their career make over $2 million more than women.
  • Nuclear medicine had the smallest pay gap ($394k vs. $382k)
  • The pay gap could contribute to higher burnout rates, with 92% of women reporting overwork compared to 83% of men. 
  • Two-thirds of physicians are considering an employment change due to overwork. 

Ironically, Doximity cited results of a recent survey in which 71% of physicians said they would accept lower compensation for better work-life balance. 

The Takeaway

The news about salaries could be a gut punch to many physicians, who are already dealing with epidemic levels of burnout. Radiology salaries bucked the trend by rising 1.6%, which could explain its popularity among medical students over the last three years. 

The question remains, is the money worth it? Rising imaging volumes have been tied to burnout in radiology, and the Doximity report indicates that some physicians are willing to forgo money for better quality of life.

Moral Distress in Radiology

The rising volume of medical imaging studies isn’t just a data point. It’s causing moral distress among radiologists and is a major systemic cause of the specialty’s burnout epidemic. 

Radiology’s problem with burnout is no secret, with a recent analysis disclosing that 54% of all radiologists identify as burned out. Studies have found that a cause of burnout can be moral distress, defined within healthcare as when a clinician knows the right course of action for a patient, but is prevented from taking it due to systemic factors.

In a March 22 study in American Journal of Roentgenology, researchers describe findings from a survey of 93 radiologists on their feelings of moral distress in different clinical scenarios and the impact it had on their careers. In short:

  • 98% reported some degree of moral distress
  • 48% thought the COVID-19 pandemic influenced their moral distress
  • 28% considered leaving their jobs
  • 18% actually did leave a job

Several factors contribute to moral distress in radiology: 

  • Case volumes that are higher than can be read safely
  • Higher case volumes that prevent resident teaching
  • A lack of action and support among administration

These latter issues lead to burnout in specific ways, the authors wrote. Institutional constraints to providing high-quality care can prompt physicians to spend more time at work. Error rates can also grow during shifts with high study volumes or that last longer than 10 hours. And orders for unnecessary imaging exams can be seen as disregard for professional expertise. 

The Takeaway

This study rips the Band-Aid off the burnout problem in radiology, pointing out that inexorably rising imaging volumes rather than bad bosses or lazy colleagues are a root cause, one that’s been exacerbated by the COVID-19 pandemic.  

A further implication is that no amount of “self-care” – often prescribed as a solution for burnout – will cure the problem in the long run as long as radiologists will have ever-growing worklists to return to after their sabbaticals and motivational staff meetings. The researchers recommended “urgent action” to address the issue.

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