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Biomedical subjects

J H Sunshine

Publications and source records attributed to J H Sunshine.

At least 37 records · Page 2Linked to original sources
PubMed1999

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

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

Employment↗
PubMed1999

Core-needle and surgical breast biopsy: comparison of three methods of assessing cost.

PURPOSE: To compare and evaluate the measures of costs for core-needle and surgical breast biopsies. MATERIALS AND METHODS: Three measures of costs were evaluated: (a) input resources, (b) actual payments, and (c) billed charges. A combination of methods were used for data collection from 10 sites enrolled in a large-scale, multiinstitutional, randomized controlled clinical trial. RESULTS: Input resource cost data (42 core-needle and eight surgical biopsies) were the most difficult to obtain. Actual payments and billed charges data collection (32 core-needle and 44 surgical biopsies) was hampered by the difficulty of obtaining data from all providers involved in the procedures. Average direct input resource costs for surgical biopsy (including needle localization) were almost three times as high as those for core-needle biopsy ($698 vs $243). Actual payments ($2,398 vs $799) and billed charges ($3,764 vs $1,496) for surgical biopsy averaged two and a half to three times higher than those for core biopsy (P < .001). CONCLUSION: There was remarkable consistency in relative costs. Input resource costs were much more difficult to obtain than were either actual payments or billed charges. However, input resource costs present a more reliable indication of the actual costs of a procedure than do the other measures. Given the difficulty in obtaining input resource costs, analyses by using actual payments may be preferred.

Adult↗
PubMed1999

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

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

Adult↗
PubMed1999

Hiring of diagnostic radiologists in 1997.

OBJECTIVE: We sought to determine the hiring activities of physician groups with respect to diagnostic radiologists. MATERIALS AND METHODS: A survey was mailed to a stratified, random sample of 589 groups of physicians in the autumn of 1997; 76% responded. Responses were weighted to represent all practices in the United States that have more than one radiologist. Findings were compared with results of similar, previous surveys. RESULTS: In the 12 months before the survey, groups sought to hire 1909 (+/-111[SE]) diagnostic radiologists; 888 (+/-77) of these jobs were new positions, the rest were replacements for radiologists who left groups. Groups did not seek to refill another 366 (+/-57) positions that had been vacated during these 12 months. Groups succeeded in hiring 1488 (+/-92) diagnostic radiologists. Generally, the percentage of available positions that groups succeeded in filling did not differ among subspecialty fields. A greater perceived effect of managed care on a group was associated with fewer expansion positions and less likelihood that positions were offered on a partnership-track basis but otherwise was unrelated to hiring activity. Eighty-one percent of available positions were in groups that preferred recently trained radiologists to those with 10-20 years' experience; 28% of full-time positions in private nonacademic groups were not partnership-track. CONCLUSION: The decline in hiring evident during 1991-1995 has reversed. In the year ending in the autumn of 1997, for the first time in recent years, positions available exceeded radiologists to fill them; the excess was approximately 278 positions.

Data Collection↗
PubMed1999

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

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

Employment↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1998

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↗
PubMed1997

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↗
PubMed1997

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↗
PubMed1997

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↗