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J H Sunshine

Publications and source records attributed to J H Sunshine.

At least 73 records · Page 4Linked to original sources
PubMed1995

The sex ratio of American radiologists: comparison and implications by age, subspecialty, and type of practice.

OBJECTIVE: The purpose of this paper is to present results related to two questions regarding changes in the sex ratio of American radiologists. Do men and women in radiology have different patterns of subspecialization, postresidency training, board certification, or practice characteristics? Do differences in patterns between the sexes imply that the number of radiologists required in the future will change with a changing sex ratio of radiologists? MATERIALS AND METHODS: A survey questionnaire was mailed to a stratified random sample of 2804 radiologists, radiation oncologists, and nuclear medicine specialists drawn from the American Medical Association Physician Masterfile. The survey achieved a response rate of 69%. Stratification criteria included sex, age, and subspecialty. The survey questions included age, sex, subspecialty, training status, board certification, type of practice, principal work activity, source of income, hours worked, and amount of time away from the practice. Data analysis used descriptive statistics, ordinary least squares regression, and logit analysis. Weighting assured that results represent all radiologists. RESULTS: Only 13% of active radiologists who have finished training are women. The percentage varies with age; 6% of radiologists 45 years old or older; 22% of those 35-44 years old, and 23% of those younger than 35 years old were women. Differences in the sex ratio were not associated with differences in board certification or postresidency fellowships, but subspecialization differed by sex. Women were more likely than men to be salaried, to work part-time, to be engaged in teaching, and to work in an office rather than in a hospital. Differences in the sex ratio had little impact on estimates of the number of radiologists that will be needed in the future. CONCLUSION: Female radiologists have subspecialization and practice characteristics different from those of male radiologists. The increasing percentage of women in the profession will have little effect on the number of radiologists and radiation oncologists needed.

Adult↗
PubMed1994

Patterns of professional organization membership among radiologists in the United States.

RATIONALE AND OBJECTIVES: The extent of membership in a professional association is an indicator of the level of cohesiveness or fragmentation of the profession. In this study, membership patterns in the American College of Radiology (ACR) were examined to assess how much different groups within radiology identify with the profession. METHODS: Patterns of membership in the ACR, the principal professional organization (as opposed to scientific society) of American radiologists, were examined by studying different demographic and professional groups within radiology. Data from the 1990 American Medical Association (AMA) Physician Masterfile were matched with ACR membership data for post-training radiologists and nuclear medicine specialists. RESULTS: Seventy-four percent of post-training American Board of Radiology (ABR)--certified diagnostic radiologists and radiation oncologists were ACR members. Membership rates were significantly lower for radiologists who were the following: 1) younger than 45 years of age; 2) women; 3) located in the western United States; 4) not certified by the ABR; or 5) listed their major professional activity as administration, teaching and research, or exclusively hospital-based patient care. Logit analysis showed that each of the above factors had a statistically significant effect on membership independently of the others. There were no statistically significant differences in membership rates between diagnostic radiologists and radiation oncologists, or between diagnostic subspecialists and diagnostic generalists. Among those with ABR certification, there was no significant difference between nuclear medicine specialists and other radiologists. CONCLUSIONS: The data suggest that, to increase the size and representativeness of ACR membership, target areas for recruitment effort might include younger radiologists, female radiologists, and radiologists located in the western United States.

Adult↗
PubMed1994

Operational characteristics of radiology groups in the United States in 1992.

PURPOSE: To determine the operational characteristics of radiology groups in the United States in 1992. MATERIALS AND METHODS: The American College of Radiology surveyed a stratified random sample of 695 radiology groups, including academic departments, units in multispecialty groups, and staff of government facilities. After intensive follow-up, a 69% response rate was achieved for in-scope groups. The responses were weighted to show what findings would have been if all radiology groups in the country had responded. RESULTS: Thirteen percent of groups practiced in a university or teaching hospital; 59%, in a nonprofit hospital; and 18%, in a proprietary hospital; 42% routinely read images obtained by other practices; and 15% were involved with mobile vans. Radiologists in diagnostic-only practices averaged 11,100 procedures per year per full-time equivalent. However, the average was about one-third lower in office-only practices and primarily academic practices. Most groups had no female radiologists. CONCLUSION: Workload data show a great deal of variability and means should not be taken as standards.

Female↗
PubMed1994

The challenge of managed care and managed competition.

Payment for health care in the United States changed rapidly during the 1980s, with the changes often identified by three-letter acronyms such as HMO, PPO, DRG, and RVS (health maintenance organization, preferred provider organization, diagnosis-related group, and relative value system). Changes are likely to be even more rapid and fundamental in the next few years. "Managed care" and "managed competition" are the principal terms being used to describe these pending changes. In this paper, we briefly present the problems that have led to changes, the changes that have occurred, the changes likely in the future, the implications of these changes for radiologists, and how radiologists can respond most effectively. We concentrate on the implications of changes for radiologists and on how radiologists can respond effectively.

Competitive Medical Plans↗
PubMed1994

Quality assessment and improvement: what radiologists do and think.

OBJECTIVE: The main objectives of the study were as follows: first to study the nature and extent of radiologists' involvement in and their attitudes toward quality assessment (QA) and continuous quality improvement (CQI)/total quality management (TQM) in hospitals and in offices; and second, to ascertain whether differences in size, type, and location among hospitals and nonhospital radiology offices affect the QA and CQI/TQM activities of radiologists. We analyzed data from a national survey conducted by the American College of Radiology (ACR) in 1993. MATERIALS AND METHODS: Questionnaires about QA and CQI/TQM activities and attitudes were mailed to 216 hospital-affiliated diagnostic radiology group practices using a sample selected from the ACR master list of radiology practices in the United States. The response rate was 90%. A stratified random sample ensured representation of different geographic regions, various group sizes, and both academic and nonacademic groups. Responses were weighted so that our data show what answers about hospitals would have been if (i) the survey had been answered by all hospital radiology departments in the United States (except for those few staffed by solo practitioners or nonradiologists) and (ii) our questions about nonhospital offices had been answered by all radiology groups in the United States (except those few having no hospital activity). RESULTS: The majority (86%) of hospital radiology departments report having a program to monitor and evaluate physicians' performances. Fifty-one percent collect incorrect diagnoses by specific radiologist. Twenty-eight percent collect some of their QA data through computerized information systems. We found some statistically significant differences by hospital size and location, with larger hospitals and urban hospitals being more likely to engage in some QA activities. Multivariate analyses, once controlled for hospital size and location, found no significant differences in QA activity between university and community hospitals or between hospitals with and without a residency program. QA and CQI programs were less common in offices than in hospitals. With the exception of mammographic interpretations, most practices did not monitor and evaluate physicians' performances in the office setting. Respondents representing 58% of hospital radiology departments thought that QA and CQI contributed to improvement in patient care. Only 19% of radiology practices answered that CQI has been of cost benefit to their organization. CONCLUSION: Most radiology practices engage in a variety of QA and CQI activities in hospitals. However, this is less true in offices, in which radiologists have more discretion, and radiologists remain skeptical about the usefulness of CQI.

Attitude of Health Personnel↗
PubMed1993

The radiology relative value scale: its development and implications.

In a proactive response to federal government cost-containment pressures, the radiology profession, under the leadership of the American College of Radiology (ACR), in 1988 developed a relative value scale (RVS) for radiologic procedures. Like earlier radiology RVSs, its relative values reflected the physician work and practice costs involved in each procedure. The RVS was constructed by using (a) three types of data (magnitude estimation, charges, and practice costs) obtained by means of surveys and (b) expert consensus panels involving participants from all fields and many organizations in radiology. The RVS was accepted, essentially in toto, by Medicare. Subsequently, the RVS has required much work to correct errors by Medicare and the insurers that administer it, to improve procedure codes, and to develop codes and relative values for new procedures. By moving proactively, radiology preserved fee-for-service against a major threat, reduced payment cuts from those that seemed to be impending, and gained a unique degree of control over its payments. However, the new payment system is complex and does not reward efficacy, cost-effectiveness, or quality.

Cost Control↗
PubMed1993

Radiology performed by nonradiologists in the United States: who does what?

OBJECTIVE: When nonradiologists perform radiologic procedures, rather than referring their patients to radiologists, utilization--and therefore costs--are high, and quality appears often to be poor. In light of these public policy concerns, the American College of Radiology developed a detailed descriptive analysis of radiology performed by nonradiologists. MATERIALS AND METHODS: Medicare data from 1989, which make up a uniform record of one third of the nation's health care, were the source of the information. These data are reasonably, although not exactly, representative of patients of all ages. We measured radiologic work, and nonradiologists' share of it, in professional component relative value units, using the Medicare radiology relative value scale. RESULTS: Nonradiologists performed 25% of all radiologic work in the United States; their share was 46% in offices and freestanding centers, 27% for hospital inpatients, and 8% for outpatients. Counting procedures (rather than work measured in relative value units), nonradiologists' share was 64% in offices and freestanding centers and 8% for inpatients. Nonradiologists performed two thirds of all work in sonography, half of interventional radiology/angiography, 15-17% of general radiology and nuclear medicine, and a few percent of CT/MR and radiation oncology. Cardiologists performed 10% of all radiologic work in the United States; internists 5%; and orthopedists, ophthalmologists, and family and general practitioners, 2% each. Almost half of radiologic work performed by nonradiologists consisted of coronary angiography and cardiac sonography, done principally by cardiologists. Radiologists do less than 5% of this work. Office and freestanding center general radiology, performed mostly by orthopedists and primary care physicians, accounted for one fourth of the radiologic work done by nonradiologists. CONCLUSION: The general radiology performed by nonradiologists is of a magnitude that easily could be transferred to radiologists, particularly because many unnecessary imaging studies would most likely be eliminated as a result. Such a transfer would reduce costs and probably improve quality but might sometimes decrease patient convenience. However, because many radiologists do not perform coronary angiography and cardiac sonography, a transfer of these responsibilities to radiologists would be problematic and likely to require extensive additional training of radiologists.

Diagnostic Imaging↗
PubMed1993

Radiologists in the United States: demographic, professional, and practice characteristics.

OBJECTIVE: The purpose of this report is to present a statistical portrait of radiologists in the United States based on the 1990 American College of Radiology Manpower Survey. Unlike previous surveys, this survey included radiologists who were not members of the College and was thus more representative of all radiologists. (Approximately three quarters of radiologists are College members.) We examined how the demographic, professional, and practice characteristics of radiologists vary among major groups within the profession. MATERIALS AND METHODS: A stratified random sample of 2804 radiologists and nuclear medicine specialists was drawn from the American Medical Association Physician Masterfile, which is the most complete and extensive single source of information on physicians in the United States. Because the total numbers of female radiologists, nuclear medicine specialists, and radiologists less than 35 years old are relatively small, these groups were deliberately "oversampled" (hence the term stratified random sample) to ensure sufficient numbers of responses in these categories for meaningful analysis. A total of 1845 completed questionnaires were received, which yields a response rate of 68% if the questionnaires sent to invalid addresses are excluded. Responses were weighted to make the data representative of all radiologists, despite differences in sampling rates. RESULTS: Findings for professionally active radiologists who completed their training included the following: 94% were certified by the American Board of Radiology, 13% were women, 47% were less than 45 years old, fees for service were the primary remuneration for 62%, and 72% are in practices owned by physician members of the practice. By major activity in radiology, 69% were diagnostic radiology generalists; 11% were radiation oncologists; 18% were diagnostic radiology subspecialists; and 2% were nuclear medicine specialists. A breakdown by age indicated that the age group of radiologists less than 45 years old included more women, diagnostic subspecialists, and persons who had fellowship training than other age groups did. Percentages of diagnostic radiology generalists and solo practitioners were lower among younger radiologists. Radiation oncologists, compared with all others, were the most likely to practice solo or in small groups of two to four members. The subfields with the highest percentages (60% or more) of diagnostic radiologists reporting expertise or proficiency were CT, mammography, and sonography. Among radiologists who were retired, half had retired by the time they were 65 years old. However, a majority of radiologists 65-69 years old were still working, as were 40% of those 70-74 years old. CONCLUSION: The profession of radiology is changing, with more women, subspecialists, and fellowship-trained radiologists in younger age groups and fewer solo practitioners. Only a small percentage of radiologists are not board certified. Radiologists typically remain professionally active into their late 60s or even beyond.

Adult↗
PubMed1992

Consequences of physicians' ownership of health care facilities--joint ventures in radiation therapy.

BACKGROUND: Physicians are increasingly the owners of health care facilities to which they refer patients for services but at which they do not practice. We studied such ownership arrangements, known as "joint ventures," in the field of radiation therapy, examining their effects on access, use of services, costs, and quality. METHODS: Because 44 percent of free-standing facilities providing radiation therapy in Florida in 1989 were joint ventures, as compared with 7 percent elsewhere (95 percent confidence interval, 3 to 10 percent), we compared data for Florida with comparable data for the remainder of the United States. We also compared radiation-therapy facilities in Florida that were established as joint ventures with those that were not. Since most data were derived from entire populations rather than from samples, any differences found were of necessity statistically significant. RESULTS: No joint-venture facilities providing radiation therapy were located in inner-city neighborhoods or rural areas, but 11 percent of other free-standing facilities and hospital-based facilities were located in such areas. Among free-standing facilities, joint ventures received 39 percent of their revenues from patients with well-paying insurance coverage, as compared with 31 percent for facilities that were not joint ventures (P < 0.01). The frequency and costs of radiation-therapy treatments at free-standing centers were 40 to 60 percent higher in Florida than in the rest of the United States; there was no below-average use of radiation therapy at hospitals or higher cancer rates that explained the higher rates of use or higher costs in Florida. Radiation physicists at joint-venture facilities (the principal personnel involved in quality control other than physicians) spent 18 percent less time with each patient over the course of treatment than did their counterparts at free-standing facilities that were not joint ventures (P < 0.05). Mortality among patients with cancer in Florida was not lower than the U.S. average, even though joint ventures are much more common in that state. CONCLUSIONS: Joint ventures in radiation therapy appear to have adverse effects on patients' access to care. They also appear to increase the use of services and costs substantially. Some indicators show that joint ventures cause either no improvement in quality or a decline. Our results add to the evidence indicating that physicians' self-referral generally has negative consequences. We recommend legislation to ban ownership of joint ventures by referring physicians. Such legislation needs to be carefully designed in order to achieve its objectives and forestall new, financially abusive arrangements.

Ambulatory Care Facilities↗
PubMed1992

Physicians' utilization and charges for outpatient diagnostic imaging in a Medicare population.

OBJECTIVES AND RATIONALE: For 10 common clinical presentations, we assessed differences in physicians' utilization of and charges for diagnostic imaging, depending on whether they performed imaging examinations in their offices (self-referral) or referred their patients to radiologists (radiologist-referral). METHODS: Using previously developed methodologies, we generated episodes of medical care from an insurance claims database. Within each episode, we determined whether diagnostic imaging had been performed, and if so, whether by a self-referring physician or a radiologist. For each of the 10 clinical presentations, we compared the mean imaging frequency, mean imaging charges per episode of care, and mean imaging charges for diagnostic imaging attributable to self- and radiologist-referral. RESULTS: Depending on the clinical presentation, self-referral resulted in 1.7 to 7.7 times more frequent performance of imaging examinations than radiologist-referral (P < .01, all presentations). Within all physician specialties, self-referral uniformly led to significantly greater utilization of diagnostic imaging than radiologist-referral. Mean imaging charges per episode of medical care (calculated as the product of the frequency of utilization and mean imaging charges) were 1.6 to 6.2 times greater for self-referral than for radiologist-referral (P < .01, all presentations). When imaging examinations were performed--including those performed in both physicians' offices and hospital outpatient departments--mean imaging charges were significantly greater for radiologists than for self-referring physicians in seven of the clinical presentations (P < .01). This result is related to the high technical charges of hospital outpatient departments; in office practice, radiologists' mean charges for imaging examinations were significantly less than those of self-referring physicians for seven clinical presentations (P < .01). CONCLUSIONS: Nonradiologist physicians who operate diagnostic imaging equipment in their offices perform imaging examinations more frequently, resulting in higher imaging charges per episode of medical care. These results extend our previous research on this subject by their focus on a broader range of clinical presentations; a mostly elderly, retired population; and the inclusion of higher-technology imaging examinations.

Aged↗
PubMed1992

Partial care in mental health organizations: United States and each state, 1988.

Partial care is a relatively new and rapidly-growing form of mental health care consisting of a planned program of mental health treatment services generally provided in visits of 3 or more hours to groups of patients/clients. In 1970, only one-fourth of U.S. mental health organizations provided partial care services, and patient additions to partial care programs were 56 per 100,000 civilian population. By 1988, close to half of all mental health organizations provided partial care services, and the rate of additions was more than 5 times as high. However, large increases in the number or organizations providing partial care between 1984 and 1988 are due in part to changes in definitions that are elaborated on later in the report. In 1988, multiservice mental health organizations were the most numerous providers of partial care with 1,230 of 1,310 (94 percent) providing this program. This was followed by general hospital mental health services with 332 of 1,489 (22 percent) providing partial care and private psychiatric hospitals with 236 of 447 (53 percent) providing this program. Mental health organizations providing partial care were most numerous in populous States, particularly in California (with 187 mental health organizations providing partial care), New York (174 organizations), and Pennsylvania (131 organizations). There were 212,196 patients on the rolls of partial care programs of mental health organizations in the United States (including Territories) at the beginning of 1988, and 286,715 patients were added to these programs during the year. Multiservice mental health organizations were responsible for a majority of both patients on the rolls and patient additions during the year.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

How accurate was GMENAC?--A retrospective review of supply projections for diagnostic radiologists.

In 1982, the Graduate Medical Education National Advisory Committee (GMENAC), a prominent national panel, predicted there would be 25,650 full-time equivalent (FTE) diagnostic radiologists, a 34% oversupply, by 1990. The radiologists involved in GMENAC, however, using models developed by the American College of Radiology, projected 19,800 FTE diagnostic radiologists in 1990, which was similar to the GMENAC estimate of need. The disagreement arose principally from different assumptions about residents entering the specialty. Recent data show there actually were approximately 21,900 FTE diagnostic radiologists in 1990. The radiologists' projection was 10% below this figure; the GMENAC projection was 17% above it. GMENAC erred principally in assuming diagnostic radiology residencies would not replace general radiology residencies, but rather be an addition to them. The radiologists erred principally in their assumption about the effects of the financial problems of hospitals on the number of residency positions. Accurate long-term projection of physician supply in individual specialties may well not be feasible.

Forecasting↗
PubMed1992

Operational, professional, and business characteristics of radiology groups in the United States.

To learn the main operational, professional, and business characteristics of U.S. radiology group practices, researchers at the American College of Radiology surveyed these groups. Major findings included the following: Approximately 30% of groups provide only diagnostic radiologic services, a similar percentage provides only radiation therapy for oncologic patients, and the remainder provides both types of services. Forty-one percent of groups practice only in hospitals, 11% practice only in an office, and 48% practice in both settings. Diagnostic-only practices average 10,000-12,000 procedures per full-time equivalent radiologist per year. Groups typically require new members to be part of the group for almost 3 years before they become full partners. Formal call schedules are nearly universal among radiology groups. Groups are becoming increasingly involved with health maintenance organizations and other "alternative delivery systems," but fee-for-service remains by far the dominant source of groups' revenue. Most studied characteristics of groups are changing relatively slowly, and trends are generally toward increasing formalization of arrangements.

Age Factors↗
PubMed1992

Hospital and office practices of radiology groups.

To obtain information on the characteristics and practices of radiology groups in the United States, the American College of Radiology conducted a group practice survey in 1989; this report presents the main survey findings about the office and hospital practices of such groups. A questionnaire and one follow-up were mailed to all 2,591 radiology groups in the United States. Responses were weighted to reflect all groups. Hospital practices averaged 0.7 diagnostic radiologic procedures (including outpatient procedures) per patient day, with little variation by hospital type. Magnetic resonance (MR) imaging and angioplasty procedures were concentrated in teaching hospitals, but this was not true of other sophisticated procedures such as computed tomography and nuclear medicine. Offices averaged 15,000 diagnostic examinations annually, with less variation than expected according to group size. In both hospitals and offices, more than 90% of technologists were registered. Outsiders (most often, referring physicians and hospitals) had a financial interest in half of all offices. MR imaging and mammography grew faster than any other examinations, but only 44% of hospital practices accepted nonreferred patients for mammography.

Ambulatory Care↗
PubMed1992

Recruiting radiologists: the 1991 hiring survey.

Recent studies present widely varying views on the radiologist staffing situation, ranging from a projected surplus of over 6,000 radiologists to an estimated shortage of 5,000. To help clarify the situation, the American College of Radiology undertook a stratified random sample survey of radiology groups' recruitment efforts and hiring results in 1991. This survey of 192 groups achieved a 78% response rate. It found that half of all groups recruited, seeking to fill a nationwide total of 1,900 positions. Larger groups were more likely to recruit than smaller ones. Groups filled 1,348 (71%) of these positions, while 552 positions remained unfilled, which was 2.8% of groups' total staff. Remaining vacancies ranged from 5% of total staff in the Northeast and 3% in the Midwest to 2% in the South and 1% in the West. The percentage of positions filled was higher (76%) in nonmetropolitan areas than elsewhere. The authors conclude that the supply of radiologists is very close to balancing the number of positions available; the disparity is about 1/10 of some numbers mentioned previously and is probably shrinking. Also, recruiting is not less successful in nonmetropolitan areas and small cities than elsewhere.

Humans↗
PubMed1992

Pension plans of radiology practices.

Despite the ubiquity of pension plans in radiology practices and their importance to employees and radiologists, no data on pension plans are available. This lack of information is particularly unfortunate given proposed government actions that would require radiology practices to extend their pension plans to cover employees of hospital radiology departments. To develop information on pension plans and to show the adverse consequences of such actions, the American College of Radiology conducted a stratified telephone survey of 120 radiology practices in the United States. Some 88% of radiology practices have retirement plans. Results indicate that 91% of hospitals already have pension plans for their employees. Under the proposed government regulations, each radiologist would be required to provide pension coverage for an average of 7.4 hospital employees who assist radiologists in their hospital-located work. Concerns about these regulations had led radiology practices to freeze or terminate 23% of their pension plans by late 1990. The negative consequences of the proposed regulations are therefore quite serious.

Interviews as Topic↗
PubMed1991

Psychiatric outpatient care services in mental health organizations, United States, 1986.

In 1986, 2,967 mental health organizations, or 62 percent of all mental health organizations in the United States (including territories), offered psychiatric outpatient care services. A total of 5.6 million patient care episodes were provided by these organized outpatient services. These episodes involved a total of 47 million visits and 2.8 million additions, and represented 69 percent of all psychiatric patient care episodes in organized settings that year. Both the number of organizations with psychiatric outpatient care services and the number of outpatient additions to these organizations increased by approximately 4 percent between 1983-84 and 1986. Multiservice mental health organizations were the most prominent type of mental health organization in the provision of psychiatric outpatient care. They comprised 42 percent of the 2,967 organizations offering this type of care and were responsible for 54 percent of the outpatient additions, 53 percent of the episodes, and 54 percent of the visits. Next in importance were freestanding psychiatric outpatient clinics and separate psychiatric services in non-Federal general hospitals. They accounted for 26 percent and 17 percent, respectively, of organizations providing psychiatric outpatient care. Each provided 12 to 18 percent of outpatient additions, episodes, and visits. Over 90 percent of multiservice mental health organizations and Veterans Administration psychiatric organizations offered outpatient psychiatric care. In contrast, this form of care was offered by only 29 percent of State and county mental hospitals, 36 percent of private psychiatric hospitals, 37 percent of nonFederal general hospitals with psychiatric services, and 23 percent of residential treatment centers for emotionally disturbed children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗