Gender differences in diagnostic radiologists' annual incomes

RATIONALE AND OBJECTIVES

Specialty, work effort, and gender have been shown to be associated with physicians' annual incomes; however, careful examination of the association between provider gender and physician incomes after correcting for other factors likely to influence income has not been conducted at the subspecialty level. We sought to determine the association between provider gender and diagnostic radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics.

MATERIALS AND METHODS

Using survey responses that were collected throughout the 1990s from 491 actively practicing white diagnostic radiologists, we generated a linear regression model to determine the association between provider gender and radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics.

RESULTS

White female radiologists reported working 2% fewer annual hours than their white male counterparts. Female radiologists had practiced medicine for fewer years than males, were more likely to be employees, as opposed to having an ownership interest in the practice, and were equally likely to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, female radiologists' mean annual income was $273,907, or $80,090 (23%) lower than that for white males (95% CI: $113,930 lower to $46,250 lower, P < .001).

CONCLUSIONS

During the 1990s, female gender was associated with lower annual incomes among diagnostic radiologists. Researchers should further explore the relationship between physician gender and incomes to determine what factors might cause the differences that we found.

Pay for Performance in Radiology: ACR White Paper

During the next few years, some portion of physician reimbursement will be increasingly based on the quality and efficiency of service, a practice commonly referred to as pay for performance (P4P). Performance benchmarks are the discrete parameters of structure, process, or outcome metrics whose attainment defines good quality care. Private payers are already rewarding primary care physicians for practices that adhere to quality standards, are efficient, involve information technology, and result in high patient satisfaction. The Centers for Medicare and Medicaid Services will have completed the development of performance measures to be used in Medicare payment strategies for all specialties by the end of 2006 and anticipates phasing in the program fully by 2008. This article describes P4P, its importance to the ACR, the organizations involved in developing it, the ACR's activities to date, and the steps the ACR must take to ensure that radiologists are remunerated fairly as physician payment becomes based, in part, on performance.

Turf Wars in Radiology: Privileging and Site Accreditation Programs—What They Have Accomplished for Commercial Health Plans

In recent years, some commercial health plans have instituted privileging and site accreditation programs for providers of diagnostic imaging. This article describes how these programs work and points out that they can help restrict self-referral and the overutilization that accompanies it. Another advantage is that they can help eliminate low-quality providers. Radiologists should encourage health plans in their area to develop and implement these measures.

The Community-Referred Radiology scheme: an evaluation

AIMS

To evaluate the Community-Referred Radiology (CRR) scheme.

METHODS

The study involved: (1) interviews with local stakeholders; (2) analysis of the number, type, and cost of referrals as well as sociodemographic characteristics of patients using the CRR database (for the year October 2003-October 2004); and (3) review of referral criteria, by an independent radiologist, of a random sample of 100 referrals.

RESULTS

The scheme was widely used, and was viewed as being highly satisfactory by general practitioners. There were 117 types of radiology investigation ordered. Chest X-ray was the most requested investigation. Women constituted 65.5% of users. Maori had a lower rate of referral compared with New Zealand (NZ) European. The average cost of investigation in the NZ European and the 'Not stated' groups was higher than in other ethnic groups. Six (6.1%) of referrals did not align with the National Radiology Referral Guidelines.

CONCLUSIONS

The CRR scheme is perceived as being a popular, well-run, and streamlined service. The comparatively low rate of radiology referral for Maori people and people living in the most deprived areas as well as the lower average cost of their tests warrant further investigation. A number of recommendations are made aimed at further enhancing the scheme.

Financing Radiology Graduate Medical Education: Today’s Challenges

Radiology graduate medical education (GME) is exposed to huge financial challenges. First, there is a continuous increase in demand for imaging services by referring doctors and the general population, aggravating the staff shortage. Second, there has been an important decline in reimbursements. Third and probably most important is the progressive reduction of federal funds subsidizing GME. Medicare is the largest single contributor to GME. The Balanced Budget Act (BBA) of 1997 introduced reductions in Medicare payments to the major teaching hospitals calculated at $5.6 billion over the first 5 years after implementation. The BBA also brought other changes directly affecting GME. Financial changes in health care over the past decade have increased the pressure on academic institutions, which must preserve or improve the quality of training and the quality of care and manage an increased workload with fewer funds available and a narrow margin for errors. Yet the use of new technology promises to help simplify processes, decreasing workloads for residents and faculty members and increasing overall productivity, and new sources of funding have been suggested. By reviewing the financial challenges of radiologic training in today's academic centers, the authors reach the conclusion that there is still space for improving academic quality and the quality of care within current financial boundaries. But more reliable data about the specific benefits and drawbacks of having a residency program in a clinical radiology department are required.

An Analysis of the Buy-Vs-Lease Decision

This article presents a financial model to analyze the buy-vs-lease decision. The model is constructed from the perspective of a lessee with an operating lease and uses the concept of net present value, which calculates the current value of predicted cash flows in the future. Predicted cash flows of an operating lease compared with buying are presented in the model, as is the after-tax borrowing rate, the appropriate discount rate used in a model of this type. The article also discusses nonfinancial factors that may influence the buy-vs-lease decision, including the need for flexibility in working capital and the anticipated technological obsolescence of equipment.

Assessment of the appropriateness of requested radiological examinations for outpatients and the potential financial consequences of guideline application

The purpose of this study was to evaluate whether requested radiological examinations for referred outpatients are in concordance with the guidelines as proposed by the consilium radiologicum. A second purpose was to evaluate the financial effect of strict guideline application. The radiological requests for 1000 referrals were evaluated by 2 radiologists. A consensus score of 74.4% guideline conformity was reached. A mean save of 9.5 Euro per patient was calculated after strict guideline application. It is concluded that guidelines are a valuable tool for patient management in referring for radiological examinations and have a substantial effect on the available budget. Further improvements and fine-tuning of the guidelines are mandatory to increase their validity.

Selected Accounts Receivable Performance Statistics for Radiology Practices: An Analysis of the Adjusted Collection Percentage and Days Charges in Accounts Receivable

OBJECTIVE

To provide comparative data and analysis with respect to accounts receivable management performance criteria.

METHODS

Data from 3 sources were analyzed: the Radiology Business Management Association's (RBMA) 2003 Accounts Receivable Performance Survey; the RBMA's 2003 Accounts Receivable Survey; and Hogan and Sunshine's 2004 Radiology article "Financial Ratios in Diagnostic Radiology Practices: Variability and Trends," the data for which were drawn primarily from the ACR's 1999 Survey of Practices. The RBMA surveyed (via e-mail and postal mail) only its members, with response rates of 15% and 9%, respectively. The ACR's survey response rate was 66%, via postal mail, and was distributed without regard to the RBMA membership status of the practice manager or even whether the practice employed a practice manager. Comparison among the survey results provided information on trends.

RESULTS

Median practice professional component adjusted collection percentage (ACP) deteriorated from 87.3% to 85.1% between the RBMA surveys. Practices limited to global fee billing faired much better when performing their billing in house, as opposed to using a billing service, with mean ACPs of 91.2% and 79.4%, respectively. Days charges in accounts receivable 2004 mean results for professional component billing and global fee billing were nearly identical at 56.11 and 55.54 days, respectively. The 2003 RBMA survey reported 63.74 days for professional component billing and 77.33 days for global fee billing. The improvement from 2003 to 2004 was highly significant for both professional component billing and global fee billing. The 2004 RBMA survey also reflected a rather dramatic improvement in days charges in accounts receivable compared with Hogan and Sunshine's results, which showed a mean of 69 days charges in accounts receivable.

CONCLUSION

The conflicting trends between ACP performance and days charges in accounts receivable performance may be explained by the increasing sophistication of accounts receivable management processes (improving days charges in accounts receivable) and the deterioration in the general economy between survey periods (decreasing ACPs). Additionally, generally better accounts receivable management performance was experienced by practices employing RBMA members (RBMA survey participants) compared with those that may or may not have employed RBMA members (ACR survey participants).

Radiology knowledge in new medical graduates in New Zealand

AIMS

To establish the level of knowledge of new medical graduates in New Zealand about common radiological investigations and to assess their ability to request most appropriate, cost-effective radiological investigations for common clinical scenarios.

METHODS

A test was developed and administered in Waikato, Christchurch, Rotorua, Auckland, and Dunedin hospitals during the first month of new house officer year (November 2002).

RESULTS

Sixty-two first year house officers participated; 59 were New Zealand medical graduates (Auckland: 24 and Otago: 35) and 3 were from overseas institutions. The mean score for questions that assessed about risks involved in common investigations, including radiation, was 47% (95% CI: 45%-49%). The mean score for selecting the appropriate clinical investigations was 53% (95% CI 52%-54%). Most significantly, only 42% (95% CI 38%-46%) of the respondents thought they had adequate radiology teaching to work as house officers. The following percentage of the respondents never observed the respective examination during their medical school training: barium enema 72% (95% CI: 60%-82%); IVU 75% (95% CI: 63%-87%); US scan 25% (95% CI: 16%-37%); CT scan 20% (95% CI: 11%-32%); angiogram 16% (95% CI: 9%-28%); MRI 42% (95% CI: 30%-54%). The mean score for the practical knowledge about common investigations was 50 (95% CI: 48%-52%).

CONCLUSIONS

Medical students report that they have limited exposure to radiology teaching during their medical school training. The test results suggest that medical school training enabled them to commence their probationary year with a 'just safe' level of radiology knowledge and skill.

Negotiating in a Managed Care World

Medical managed care, once thought to be a passing influence affecting large urban markets only, has proven to be a dominating factor in virtually every medical practice in the country. Discounted rates, steerage, utilization management, pay for performance, and other managed care strategies are likely to be a provider's reality for the foreseeable future. It is imperative that physicians develop negotiating skills and educate themselves about how to negotiate not only rates but also the other components discussed herein that ultimately determine the economic viability of a managed care agreement.