The employment experience of 1995's graduates.
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Education, Medical, Graduate↗
Biomedical subjects
J H Sunshine
Publications and source records attributed to J H Sunshine.
Characteristics of radiology groups and of diagnostic radiologists and radiation oncologists in different types of practices.
PURPOSE: To describe the characteristics of U.S. radiology groups and of radiologists in different types of practices in 1995. MATERIALS AND METHODS: A survey was distributed to 3,024 radiologists; the response rate was 75%. Responses were weighted to represent all U.S. groups or radiologists. RESULTS: There were 3,285 groups; 340 were academic, and 356 were multispecialty. Fifty percent of groups had two to four members; 39% of radiologists were in groups with fewer than eight members, and 8% were solo practitioners. Seventy percent of all radiologists were in practices owned entirely by physicians in the practice, and 80% of these were themselves owners. Eight percent of radiologists were in government-owned practices, and 15% (primarily academic) were in privately-owned practices in which all physicians were employees. Sixty-nine percent of academic diagnostic radiologists worked primarily in one field, but this was true of only 22% of those in nonacademic groups. Solo diagnostic practitioners also typically had a broad practice but excluded high-cost modalities. Radiologists in nonacademic groups averaged more vacation days (30 d/yr) than academic (19 d/yr) or solo (12 d/yr) practitioners. Solo and locum tenens practitioners were relatively old; academic radiologists, relatively young. CONCLUSION: Through 1995, average group size has grown slowly. There are important differences among practice types, especially between academic and nonacademic practices.
Academic Medical Centers↗
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.
Humans↗
A promising start on overall imaging quality, but far to go on costs.
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Blue Cross Blue Shield Insurance Plans↗
Women in the radiology profession: data from a 1995 national survey.
OBJECTIVE: This report provides an in-depth picture of similarities and differences in the professional and practice characteristics of women and men who are radiologists in the United States, with specific attention to whether gender differences are less pronounced among younger radiologists. MATERIALS AND METHODS: Data were taken from a national stratified random sample survey of radiologists. The response rate was 75%. The 1731 men and 294 women responding included diagnostic radiologists, radiation oncologists, and radiology-related nuclear medicine specialists. RESULTS: Seven percent of respondents who completed their radiology residency before 1970 were women, compared with 9% in 1970-1979, 19% in 1980-1989, and 27% in 1990-1995. Gender differences were smaller among posttraining radiologists younger than 40 years old than among those 40 years old or older for the following questions: when the respondent decided to specialize in radiology, whether the respondent is a subspecialist within diagnostic radiology, whether the respondent's practice is primarily academic, whether the practice is privately owned, and whether the respondent is a practice owner (partner, shareholder). Women who were residents and fellows more frequently indicated problems with unwanted sexual attention occurring in the past 2 years than did women who were not in training positions. However, posttraining women were more likely to have encountered discrimination in salary, hiring, or promotion at some time in their careers. CONCLUSION: Women's professional roles in radiology are changing slowly. A narrowing gender gap among younger radiologists on some professional and practice characteristics may indicate a further diminishing of gender differences in radiology in the future. It may also reflect greater gender equality at earlier rather than later stages of one's career.
Adult↗
Practice patterns of radiologists and nonradiologists: nationwide Medicare data on the performance of chest and skeletal radiography and abdominal and pelvic sonography.
OBJECTIVE: We assessed the relative roles of radiologists and nonradiologists in performing chest and skeletal radiography and nonobstetric abdominal and pelvic sonography. MATERIALS AND METHODS: Information was extracted from the 1993 Medicare file on procedure volume for 65 imaging procedures. Claims were categorized by the specialty of the physician and the location (office or hospital) where the service was performed. RESULTS: In hospitals, radiologists performed virtually all chest and skeletal radiography and nonobstetric abdominal and pelvic sonography. In nonhospital settings such as offices or imaging centers, nonradiologists performed approximately two thirds of the chest and spinal radiography and nonobstetric abdominal and pelvic sonography and larger percentages (78-86%) of the pelvic, hip, lower extremity, and upper extremity radiography. CONCLUSION: Although radiologists perform virtually all chest and skeletal radiographs and abdominal and pelvic sonograms obtained in hospitals, they perform a distinct minority of these procedures in nonhospital settings. The data we present have certain implications for the amount of training nonradiologists receive in diagnostic imaging.
Bone and Bones↗
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.
Adult↗
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.
Employment↗
Profile of U.S. radiologists at middecade: overview of findings from the 1995 survey of radiologists.
PURPOSE: To profile the demographic, professional, and practice characteristics of diagnostic radiologists and radiation oncologists in the United States. MATERIALS AND METHODS: Questionnaires mailed to a national stratified random sample of 3,024 diagnostic radiologists, radiation oncologists, and nuclear medicine specialists yielded a 75% response rate. Weighted data reflect what responses would be if all radiologists had been surveyed and had responded. RESULTS: Among professionally active, posttraining radiologists in 1995, 14% were women; 12% were radiation oncologists, 62% diagnostic generalists, and 26% diagnostic subspecialists; 92% were board certified in radiology; 48% had postresidency fellowship training; 69% were in a position where practice ownership was a potential, and of these, 80% were practice owners. Enjoyment of work was less the greater the perceived effect of managed care on a radiologists practice, but average work satisfaction was unchanged from 1990. Among radiologists aged 55 years or older, the percentage who were retired was unchanged from 1990. Average hours worked by professionally active radiologists aged 65 years or older increased since 1990. CONCLUSION: Despite the spread of managed care and other trends that affect radiologists, surprisingly, few changes were evident in the demographic or professional characteristics of U.S. radiologists in 1995 compared with 1990.
Adult↗
Rapid method for rigorous assessment of radiologic imaging technologies.
Rapid and rigorous technology evaluation is important for improving quality and cost in health care, particularly for swiftly changing, highly technologic fields like radiology. Currently, however, evaluations are generally seriously deficient in quality, and rigorous evaluations typically require 4 years or more. Therefore, the authors developed an appropriate methodology. Its principal characteristics include study of outcomes, clinical relevance, multi-institutional design, intensive communication, experienced data management and statistical centers, sophisticated analysis, careful attention to the protocol and reference standard, on-site managers, and extensive pretesting and refinement. The authors successfully tested the methodology in a seven-institution study. Completed in 1 1/4 years, the study achieved active participation of treating physicians, which much enhanced the clinical relevance of the end points studied. The data supported extensive analyses, which included the effect of imaging on treatment plans, an important outcome measure. The authors report the (limited) difficulties encountered and identify changes to ameliorate them. Thus revised, the methodology can serve as a model for future technology assessments.
Technology Assessment, Biomedical↗
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.
Attitude of Health Personnel↗
Who performs neuroimaging? Results from the 1993 National Medicare Database.
PURPOSE: To determine the level of participation of nonradiologists in computed tomography (CT) and magnetic resonance (MR) imaging of the brain, head and neck, and spine at hospitals and at private offices and imaging centers in the United States. MATERIALS AND METHODS: The 1993 Part B Medicare Annual Database was used to determine the number of procedures performed by radiologists and nonradiologists at hospitals and at private offices or imaging centers. The fourth edition of the Physicians' Current Procedural Terminology was used to classify procedures. RESULTS: Of the 3,883,391 neurologic CT and MR imaging studies billed to Medicare in 1993, 3,148,088 (81%) were obtained in a hospital setting; only 58,005 (2%) of these studies were interpreted by nonradiologists. Of the 735,303 imaging studies (19%) obtained at a private office or imaging center, only 63,115 (9%) studies were interpreted by nonradiologists. Overall, nonradiologists performed only 121,120 (3%) of the neuroimaging examinations billed to Medicare nationwide in 1993. CONCLUSION: The level of participation of nonradiologists in the interpretation of results from neurologic CT and MR imaging billed to Medicare is minimal.
Central Nervous System Diseases↗
Hiring by radiology groups in 1996.
PURPOSE: To determine the hiring activity of radiology groups in 1996. MATERIALS AND METHODS: A survey was mailed to a stratified, random sample of 794 radiology groups in autumn 1996. The response rate was 78%. Responses were weighted to be representative of all of the approximately 3,300 groups in the United States. Findings were compared with those of previous, similar surveys. RESULTS: In the 12 months before the survey, groups sought to hire 1,732 +/- 155 (+/- 1 standard error) diagnostic radiologists and radiation oncologists; 788 +/- 105 of these positions were to fill expansion positions, 562 +/- 86 were replacements for persons who had left the profession, and 382 +/- 78 were replacements for persons who moved to other radiology positions. During the year, an additional 500 +/- 119 positions were vacated that groups did not seek to refill. Groups succeeded in hiring 1,438 +/- 143 radiologists. The percentage of available positions that were filled did not differ across fields. Managed health care reduced the probability a group was expanding but did not otherwise affect hiring activity. CONCLUSION: The 1991-1995 decline in hiring has ceased and perhaps even reversed. There were approximately as many positions available in 1996 as were needed by graduates, although there may have been a small shortfall.
Data Collection↗
The employment market for 1996 diagnostic radiology and radiation oncology graduates: training program directors' point of view.
OBJECTIVE: In light of concerns about the job market, we describe the employment situation for 1996 graduates and the status and plans of training programs. MATERIALS AND METHODS: In April-May 1996, and in a December follow-up, we surveyed all radiation oncology residency directors and a 50% random sample of diagnostic radiology residency directors about the employment situation of their 1996 residency and fellowship graduates and about their programs. One hundred percent of those surveyed responded. We compared findings with similar 1995 surveys. Differences were assessed with t tests, with a p value less than or equal to .05 as the test of significance. RESULTS: Unemployment 6 months after graduation was 0.8% for diagnostic fellows and less for other categories. Approximately 91% of graduates had positions that reasonably matched their training and personal employment goals. Our survey showed that programs have reduced beginning residency slots by 6% in diagnostic radiology and 4% in radiation oncology over the last 3 years. Program directors plan additional reductions of 3% and 29%, respectively, for total reductions in diagnostic radiology of 9% and in radiation oncology of 33%. Many observers were dismayed because of the low percentage of available slots that filled in the 1996 National Resident Matching Program. However, as in previous years, by late April to mid May 1996, more than 92% of beginning-year residency slots were filled. CONCLUSION: Unemployment continues to be low. "Soft" indicators such as the percentage of graduates with unsuitable positions show no deterioration. However, if major surpluses of diagnostic radiologists or radiation oncologists are pending, both the reductions in program size and the failure to fill all available slots are, to date, too minor to offer significant relief. Given the small size of actual reductions so far, the reported plans for large reductions of radiation oncologists seem questionable.
Data Collection↗
Manpower needs for radiation oncology: a preliminary report of the ASTRO Human Resources Committee. American Society for Therapeutic Radiology and Oncology.
In summary, the ASTRO Committee on Human Resources believes that there is ample evidence for the existence of an oversupply of radiation oncologists in the United States at the present time. It believes that this oversupply has already affected the specialty in a variety of ways that are difficult to measure, for example, increased competition, conflicts between radiation oncology groups, conflicts between the private sector and academics, and increased costs, and that it is beginning to have a significant effect on the job market. This oversupply came about because of the rapid expansion in medical school enrollment in the 1970s. This led to an increased number of graduates available for enrollment into specialty residencies, one of which was radiation oncology. The actual number of radiation oncology residency positions offered has not changed significantly since 1972. However, only about half of the residency positions were filled in the early years. Since 1986, virtually all radiation oncology training positions in the United States have been filled, and this has led to a significantly greater number of radiation oncologists entering the field than have left the field through death or retirement. Preliminary data suggest that a shift to a managed care system would result in decreased demand for radiation oncology services, and that would increase the manpower problem for our specialty.
Adult↗
Too many radiation oncologists? An empirical report.
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Employment↗
Hiring by radiology groups in 1994.
PURPOSE: To assess the hiring activities of radiology groups in 1994 and changes between 1991 and 1994 in the employment market for diagnostic radiologists and radiation oncologists. MATERIALS AND METHODS: Questionnaires about recruitment and hiring were mailed to a stratified random sample of radiology groups in the United States; 92% (341 groups) responded. Data were compared with a 1991 telephone survey that included responses from 150 radiology groups. RESULTS: In 1994, radiology groups sought candidates for approximately 1,600 positions, a 29% decline from 1991. Fifteen percent of positions were in radiation oncology, 52% in general diagnostic radiology, and 33% in diagnostic subspecialties. As in 1991, groups filled three-fourths of their openings. The percentage of openings filled did not differ statistically significantly from one field or subspecialty to another. CONCLUSION: Available positions declined sharply. However, approximately 400 positions remained vacant at the end of the hiring season, with groups still actively recruiting for 75% of them. Employment is about equally difficult regardless of field.
Employment↗
Utilization of radiologic services in different payment systems and patient populations.
PURPOSE: To report population-based utilization rates and their variability across and within populations, geographic areas, and different payment systems for diagnostic radiology and radiation oncology procedures. MATERIALS AND METHODS: Aggregated claims data were obtained from four sources for up to nine radiologic modalities. The data cover Medicare, health maintenance organizations (HMOs), and conventional insurance. For some sources, the data were separated into four age groups. All radiologic services, including those provided by nonradiologists, were included. RESULTS: Average annual ambulatory diagnostic radiology utilization rates ranged from 570 procedures per 1,000 nonelderly persons in an HMO setting to 1,970 per 1,000 for Medicare enrollees. Radiation oncology utilization rate added 11 procedures per 1,000 to the HMO population rate and 260 per 1,000 to the Medicare population rate. In the Medicare data, the diagnostic radiology utilization rate in the 25th percentile state was 78% of the rate in the 75th percentile state. In a small sample of HMOs, the 25th percentile HMO rate was 45% of the 75th percentile HMO rate. CONCLUSION: Much variability exists in utilization rates. National or regional averages are not a good guide to the utilization rates in a specific patient population and should not be taken as norms. Only actual data from a patient population are likely to provide radiologists with fairly accurate predictions of their future utilization rates.
Adolescent↗