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J H Sunshine

Publications and source records attributed to J H Sunshine.

At least 55 records · Page 3Linked to original sources
PubMed1997

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↗
PubMed1997

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↗
PubMed1997

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↗
PubMed1996

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↗
PubMed1996

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↗
PubMed1996

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↗
PubMed1996

Too many radiologists? Update.

In light of the growing concern that a large surplus of diagnostic radiologists is pending, the authors (a) reviewed the major projections of the surplus-shortage situation made during the past quarter century and (b) semiquantitatively analyzed factors widely expected to have a substantial effect on the future situation. Projections uniformly were seriously mistaken. Some factors expected to affect the future, such as the increasing percentage of women among radiologists, are foreseeable and have small effects. However, other factors, most notably new technology, cannot be predicted, although their effects may be very large. The authors conclude that the long-term future situation is not predictable. The authors also examined steps that might be taken to reduce the supply of radiologists if a large surplus were known to be pending and antitrust prohibitions against coordinated responses were eliminated. At first, there appear to be multiple actions possible that would reduce the number of graduates of residency programs while preserving, or even enhancing, quality and equity. Closer examination, however, shows that these actions are often conflicting, sometimes not actually desirable, and generally troubled by questions of effectiveness and feasibility of implementation. Thus, even with changes in the law, the authors find no ready solutions to a possible large oversupply of radiologists.

Female↗
PubMed1996

The employment market for 1995 graduates of diagnostic radiology and radiation oncology training.

OBJECTIVE: Despite widespread concern that a major surplus of non-primary-care physicians is developing, little nonanecdotal information has been available. Therefore, we developed and applied a methodology for appraising the situation of new graduates. Graduates should be particularly vulnerable because, unlike seasoned physicians. they all must find employment. MATERIALS AND METHODS: In April-May 1995, and in a December follow-up, we surveyed diagnostic radiology and radiation oncology training program directors about the status of their 1995 residency and fellowship graduates, their programs, and the employment market. More than 90% responded. We compared findings with similar 1994 surveys. Differences were assessed with t tests or multiple regression analyses, with a p value of less than or equal to .05 as the test of significance. RESULTS: Directors reported unemployment 6 months after graduation was 0.6% (+/- 0.3%) for diagnostic radiology fellows and less for others. They said approximately 90% of graduates had positions reasonably matching their training and personal employment goals. Reported unemployment rates and percentages of graduates in desired positions did not differ from 1994. However, training directors generally were more pessimistic in 1995, overwhelmingly reporting the employment market was more difficult than in recent years. Few statistically significant differences among subgroups--including diagnostic subspecialties--were found. Net planned changes in program size will generate reductions of at most a few percent in the annual number of graduates, and more than 98% of beginning year residency slots were filled. CONCLUSION: Unemployment was remarkably low. Also, surprisingly, even "soft" indicators such as undesired positions or difficulties during the process of employment search (i.e., in April-May) did not show deterioration. Projections of pending physician surpluses may be exaggerated. Given our findings, program directors' growing pessimism is puzzling. This pessimism has not called forth sizable cuts in program size and, if major surpluses are pending, neither reductions in program size nor failure to fill all available slots offer significant relief, at least to date. The employment market is about equally good (or equally difficult) across diagnostic subspecialties. The absence of regional differences indicates graduates are effectively reaching beyond the locality where they trained in their employment search.

Data Collection↗
PubMed1996

The demand side of the job market for diagnostic radiologists and radiation oncologists: hiring by physician groups in 1995.

OBJECTIVE: The American College of Radiology sought to assess the hiring activities of radiology groups in 1995, the 1995 employment market for diagnostic radiologists and radiation oncologists, and changes in the employment market since 1991. MATERIALS AND METHODS: We mailed surveys about recruitment and hiring to a stratified random sample of 600 radiology groups in the United States; 85% responded. The responses were weighted to show what they would have been if all of the approximately 3150 radiology groups in the United States had answered the survey. The findings were compared with similar surveys conducted in 1994 and 1991. RESULTS: In 1995, 31% (+/- 1% [SE]) of radiology groups actively recruited diagnostic radiologists or radiation oncologists, seeking to fill 1423 (+/- 119) openings. These figures represent a progressive decline from the 50% of groups recruiting and 2255 positions offered in 1991. In 1995, radiology groups filled 85% of available positions, compared with 76% in 1994 and 71% in 1991. In 1995, positions available because of expansion of radiology groups numbered 613 (+/- 73), considerably fewer than the estimated 720-position increase that takes place each year in the number of posttraining diagnostic radiologist and radiation oncologists in practice. In 1995, general diagnostic radiology accounted for approximately 48% of the full time-equivalent radiologists sought; radiation oncology, 11%; and the diagnostic subspecialties, 41%. We found few statistically significant differences among specialty and subspecialty fields in the percentage of available positions filled. Private, nonacademic groups offered 77% of their positions on a partnership track basis. Groups strongly affected by managed care recruited fewer radiologists and offered fewer expansion positions than similar groups that were less affected by managed care. However, managed care did not influence whether positions were offered on a partnership basis. CONCLUSION: Available positions continued to decline, and the shortfall of expansion positions relative to the annual growth in the workforce may generate serious employment problems. Managed care is having a negative effect on employment opportunities for radiologists. Gaining employment remains about equally difficult, regardless of field. The approximately 200 positions that remained unfilled at the end of the 1995 hiring season did not result from a mismatch between radiologists' skills and the qualifications that radiology groups were seeking.

Data Collection↗
PubMed1995

Multicenter trial to evaluate vascular magnetic resonance angiography of the lower extremity. American College of Radiology Rapid Technology Assessment Group.

OBJECTIVES: To assess the value of magnetic resonance angiography (MRA) in presurgical evaluation of patients with severe lower limb atherosclerotic occlusive disease and to assess the feasibility of rapidly conducting rigorous technology assessment. DESIGN: Blinded, prospective study of consecutive patients with signs or symptoms of severe infrainguinal peripheral vascular disease who were candidates for percutaneous or surgical intervention. Using both descriptive statistics and multivariate logistic analyses, MRA was compared with contrast arteriography (CA) (the current technique) for imaging 15 arterial segments of the leg and foot. Intraoperative contrast angiography was the "gold" standard. Also studied was the effect of adding MRA to the information used in planning treatment. SETTING: Six US hospitals, one a community hospital. PATIENTS: A total of 155; 84% with either rest pain or tissue loss. RESULTS: Sensitivity in distinguishing patent segments from completely occluded segments was 83% for CA and 85% for MRA; both had 81% specificity. For distinguishing near-normal segments (suitable as bypass graft termini), CA was less sensitive than MRA (77% vs 82%), but more specific (92% vs 84%). After adjusting for same-reader effects, odds of correctly distinguishing patent segments were 1.6 times as great for MRA as for CA (P < .01); for distinguishing near-normal segments, the odds for CA were 1.5 times as great as for MRA (P < .05). The addition of MRA changed the treatment plan in 13% of patients; in 86% of these cases, the surgery actually performed indicated that the MRA-inclusive plan was superior. CONCLUSIONS: Individually, MRA and CA are approximately equivalent in diagnostic accuracy. The addition of MRA to treatment plans based only on CA and other diagnostic information clearly improves the plans. Completed in 15 months (as planned), our study demonstrates the feasibility of conducting rigorous technology assessment rapidly enough to be timely even in fields in which diagnostic and treatment techniques are rapidly changing.

Adult↗
PubMed1995

How U.S. radiologists use their professional time: factors that affect work activity and retirement plans.

PURPOSE: To determine what demographic, professional, and practice characteristics are related to the amount of time radiologists work per week, to their allocation of time among professional activities, and to their plans for retirement. MATERIALS AND METHODS: The American College of Radiology surveyed 2,804 radiologists and nuclear medicine specialists. Means and percentiles were calculated for the radiologists' number of hours and days worked per week, number of weeks away, percentage allocation of time, and retirement intentions. Multiple linear and logistic regression analyses were performed. RESULTS: Full-time, post-training radiologists worked a mean of 50 hours per week. Radiologists spent 2 weeks on professional education and 4.4 weeks on vacation each year. On average, 68% of professional time was spent on hospital patient care; 18%, on office patient care; 7%, on teaching and research; and 5% on administration. Forty-one percent of radiologists planned to eventually work part-time; 47% intended to retire fully. CONCLUSION: These data will provide an important baseline for modeling the future size of the radiologist workforce and for assessing changes in the ways radiologists use their time and plan their futures.

Adult↗
PubMed1995

Professional and business characteristics of radiology groups in the United States: 1992.

PURPOSE: In response to requests, to present information on the professional and business characteristics of radiology groups. MATERIALS AND METHODS: The American College of Radiology surveyed a stratified random sample of radiology groups, defining radiology group as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. The 465 responses (69% response rate) were weighted so the data show what findings would have been if all radiology groups in the country had responded. RESULTS: ACR professional standards are widely used, particularly those for mammography and radiation oncology. Seventy-eight percent of groups required continuing training of their technologists. On average, groups required 2.7 years for new members to become full partners. The average group gave full-time radiologists 11 holidays, 26 vacation days, and 11 days for continuing medical education each year. On average, groups collected 71% of total billings. Net collections (after "allowances" for Blue Shield, Medicare, and other payers are deducted from billings) averaged 86%; half of services were provided by groups with net collection rates of 90% or more. CONCLUSION: In general, changes since 1989 (when the previous Group Practice Survey was conducted) were small.

Data Collection↗
PubMed1995

U.S. radiologists' satisfaction in their profession.

PURPOSE: To determine characteristics associated with differences among radiologists in professional satisfaction and the effect of satisfaction on career plans. MATERIALS AND METHODS: The American College of Radiology surveyed 2,804 radiologists and nuclear medicine specialists in the United States. Single-variable and multivariate analyses were performed. RESULTS: Sixty-five percent of radiologists were currently satisfied with their profession; 31% were more satisfied than they were 5 years ago, 32% felt the same, and 37% were less satisfied. Current satisfaction was most likely for radiologists with a diagnostic radiology subspecialty, board certification, age over 45 years, an academic practice, a salaried position, a full-time practice, urban location, and location in the West. Professional satisfaction relative to that 5 years ago was particularly high for (among others) young radiologists. Poorly satisfied radiologists were more likely to plan a career change and eventual part-time work. Female radiologists were as satisfied as males. CONCLUSION: This study identifies sources of radiologists satisfaction and dissatisfaction and effects of satisfaction on career plans.

Adult↗
PubMed1995

Hospital activities of radiology groups in the United States: results of a 1992 ACR survey.

OBJECTIVE: To describe the hospital activities of radiology groups in the United States, including the characteristics of hospitals at which groups practice, workload and staffing at these hospitals, and groups' professional and business arrangements at these hospitals. MATERIALS AND METHODS: The American College of Radiology surveyed a stratified random sample of radiology groups, defining a radiology group as any practice with two or more radiologists or radiation oncologists, including private groups, academic or multispecialty groups, and staffs of government facilities. All groups were directed to complete a detailed, two-page hospital information sheet (HIS) for each hospital at which they practiced. Sixty-nine percent of groups responded, and we obtained HISs for 86% of their hospitals. These responses were weighted to make our results representative of all U.S. hospitals at which radiology groups practice. RESULTS: Radiology groups reported performing on average 47,800 diagnostic procedures annually at hospitals. The average number of diagnostic procedures (inpatient plus outpatient) performed was 0.8 per inpatient day. This number varied greatly from hospital to hospital. A full-time equivalent (FTE) diagnostic radiologist at a hospital performed on average 11,400 procedures annually. Again, variation was large; the 25th percentile was 7000 procedures annually per FTE, and the 75th percentile was 14,100 procedures. Radiation oncology services were mainly provided at larger hospitals (more than 300 beds). On average, the annual number of new oncology patients at hospitals offering radiation oncology services was 380, and these patients received an average of 8435 fractions. Groups accepted nonreferred patients for mammography at 42% of hospitals at which they provided diagnostic services, and they provided 24-hr coverage for diagnostic radiology at 80% of the hospitals at which they provided diagnostic services. CONCLUSIONS: Radiologists can use the findings from this survey to evaluate their hospital practice. The workload data show considerable variation, and averages should not be taken as standards.

Accounts Payable and Receivable↗
PubMed1995

The employment market for diagnostic radiologists and radiation oncologists: an update.

OBJECTIVE: In response to concern throughout the profession about the employment market for radiologists in the United States, the American College of Radiology, through several information-gathering activities, is monitoring the situation, including the amount of hiring done, job vacancies, and unemployment. To provide context, we compare our findings with data for earlier years and for all physicians. MATERIALS AND METHODS: The American College of Radiology undertook systematic sample surveys of approximately 60 training program directors with regard to their graduates; 3000 radiologists with regard to unemployment; and 400 radiology groups with regard to hiring. Good response rates (> or = 70%) were achieved; separate data for radiation oncology and diagnostic radiology are generally available. Data on use of the College's placement service also are presented. RESULTS: Among trainees completing a diagnostic radiology fellowship or a radiation oncology residency in 1994, 1% (standard error = 1%) were unemployed in December 1994 and 15% (standard error = 4%) were working in jobs not in keeping with their training and employment goals. Among all radiologists, the 1994 unemployment rate was 0.5% (standard error = 0.2%). Radiology groups were hiring for approximately 1600 positions in 1994, of which about three fifths were replacements and two fifths were expansions. After hiring was completed, remaining vacancies numbered approximately 400, or 2% of the radiology workforce. In early 1995, program directors reported that trainees completing a residency or fellowship in 1995 were having greater difficulty finding positions than had their 1994 counterparts. CONCLUSION: The unemployment rate for radiologists was similar to that for all physicians and lower than that for other persons with advanced degrees (1.5-2%). In 1994, expansion positions for which groups were hiring nearly equaled the growth of the radiology workforce. However, 1994 hiring (and vacancy) rates were only approximately 70% of 1991 levels. It is clear that the employment market is weakening; however, contrary to some anecdotal reports, a large-scale collapse has not occurred.

Employment↗
PubMed1995

Outside financial interests in radiology offices: prevalence, payment, and practice patterns in involved offices.

OBJECTIVE: The purposes of our study were to (1) investigate the prevalence of different patterns of outside financial interests in radiology offices and of different methods of compensating these interests and (2) determine how the professional, operational, and practice characteristics of the offices vary with the patterns of outside interest. The term "office" means nonhospital practice sites, including those called imaging centers or clinics; "outside interests" refers to parties other than physicians in the group of physicians who serve the office. MATERIALS AND METHODS: Data are for 516 office sites served by radiology groups. Data were collected as part of a national, stratified random sample survey of radiology groups in the United States done by the American College of Radiology in 1992. Responses were weighted to make the results representative of all radiology groups in the United States with offices. RESULTS: Parties other than the physicians in the practice serving an office had a financial interest in 41% of offices. In about half of these (20% of all offices), physicians in the practice had no financial interest at all. The most common categories of outside financial interest were referring physicians (21%), hospitals (19%), and non-physician entrepreneurs (12%); some offices reported more than one type of outside financial interest. All categories were more common in high-tech offices (offices that offered CT, MR imaging, or nuclear medicine studies) than in non-high-tech offices. Overall, 50% of high-tech offices and 35% of non-high-tech offices had outside financial interests. The most common method of compensating outsiders was giving them shares or dividends or a percentage of the profits. The average number of procedures per full-time-equivalent radiologist was higher in offices in which only outsiders (and not the group serving the office) had a financial interest than in other offices, and fewer of the former offices offered mammography. Offices with no outside interests were more likely than those with any outsiders to regularly do chest, spinal, gastrointestinal, and urologic procedures. CONCLUSIONS: Outside financial interests, and the problems of cost and access they may engender, are fairly common in radiology offices. Nationally, joint ventures including referring physicians, which are now under legal attack, number more than 500. Differences in who owns radiology offices were associated with statistically significant variations among offices in workload, staffing, and types of procedures done.

Analysis of Variance↗