Radiation oncologists in 2000: demographic, professional, and practice characteristics

Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012

PURPOSE

The purpose of this study was to determine trends in radiation oncology malpractice claims and expenses during the last 28 years and to compare radiation oncology malpractice claims to those of other specialties.

METHODS AND MATERIALS

We performed a retrospective analysis of closed malpractice claims filed from 1985 to 2012, collected by a nationwide medical liability insurance trade association. We analyzed characteristics and trends among closed claims, indemnity payments (payments to plaintiff), and litigation expenses. We also compared radiation oncology malpractice claims to those of 21 other medical specialties. Time series dollar amounts were adjusted for inflation (2012 was the index year).

RESULTS

There were 1517 closed claims involving radiation oncology, of which 342 (22.5%) were paid. Average and median indemnity payments were $276,792 and $122,500, respectively, ranking fifth and eighth, respectively, among the 22 specialty groups. Linear regression modeling of time trends showed decreasing total numbers of claims (β = -1.96 annually, P=.003), increasing average litigation expenses paid (β = +$1472 annually, P ≤ .001), and no significant changes in average indemnity payments (β = -$681, P=.89).

CONCLUSIONS

Medical professional liability claims filed against radiation oncologists are not common and have declined in recent years. However, indemnity payments in radiation oncology are large relative to those of many other specialties. In recent years, the average indemnity payment has been stable, whereas litigation expenses have increased.

Radiologists' clinical practice of neuroimaging

PURPOSE

Because of the importance of neuroimaging as a radiology subspecialty, the aim of this study was to provide a detailed portrait of the demographics, clinical activities, and practices of radiologists heavily involved in neuroimaging.

METHODS

The authors analyzed data from the ACR's 2003 Survey of Radiologists, a large, stratified random-sample survey in which respondents were guaranteed confidentiality. The survey achieved a 63% response rate, and responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Three-fourths of US radiologists reported doing neuroradiology; 9% reported that neuroradiology was their main subspecialty, and 9% reported spending more than 50% of their clinical work time doing neuroradiology. Of these latter two categories, more than about 75% had certificates of added qualification (CAQs) in neuroradiology, and more than 80% had done neuroradiology fellowships. However, of those spending more than 50% of their clinical work time doing neuroradiology, 7% neither had CAQs nor had done fellowships in the field. One-fourth of radiologists with CAQs or who had done neuroradiology fellowships spent less than 30% of their clinical work time doing neuroradiology. One-third to one-half of neuroimaging was performed by radiologists not heavily involved in the field. Only 6% to 8% of radiologists heavily involved in the field were women, compared with 22% in other subspecialties.

CONCLUSIONS

Neuroimaging has the great strength of being a relatively well-integrated subspecialty in that a very large majority of those heavily involved in its practice have CAQs and did fellowships in the field. Among possible concerns are the relatively few women in the field and the apparent waste of expertise resulting from one-fourth of those with neuroradiology subspecialty training or certification being relatively little immersed in its practice.

Radiation Oncologists in the United States

PURPOSE

To provide an extensive and detailed portrait of radiation oncologists, their professional activities, and the practices in which they work.

METHODS AND MATERIALS

We analyzed non-individually identified data from the American College of Radiology's 2003 Survey of Radiation Oncologists, a stratified random sample survey that guaranteed respondents' confidentiality and achieved a 68% response rate, with a total of 472 responses. Responses were weighted to make them representative of all radiation oncologists in the United States. We use two-tailed z tests of percentages and means to compare information from the current survey with those from a similar 1995 survey.

RESULTS

The number of posttraining, professionally active radiation oncologists grew from nearly 2900 in 1995 to nearly 3500 in 2003, an increase of approximately 21%. Twenty-three percent of posttraining, professionally active radiation oncologists were women. Among posttraining, professionally active radiation oncologists, 95% were board-certified. Forty-eight percent of radiation oncologists were in nonacademic, radiation-oncology-only private practices; 20% in academic practice; 14% in nonacademic, multispecialty practices; and 11% in solo practice. The largest percentage of radiation oncologists worked in the South (34%). The average annual number of patients treated (curative and palliative) per radiation oncologist was 264. On average, radiation oncologists preferred a 4% increase in their workload. The proportion of radiation oncologists planning a career change decreased from 8% in 1995 to 4% in 2003, and in 2003 34% said they were enjoying radiation oncology more than 5 years earlier, compared with 21% in 1995.

CONCLUSION

Despite concerns in 2003 about lower-than-optimal workload, professional satisfaction, if anything, increased since 1995.

A Portrait of Breast Imaging Specialists and of the Interpretation of Mammography in the United States

OBJECTIVE

Because of the importance of breast imaging as a radiology subspecialty and concerns about malpractice, the purpose of our study is to provide a detailed portrait of breast imaging specialists, their professional activities and practices, and information on all radiologists who interpret mammograms.

MATERIALS AND METHODS

We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a large, stratified random sample survey that achieved a 63% response. Responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Approximately 10% of all radiologists, or 2,700-2,800 radiologists, are breast imaging specialists, but 61% of radiologists interpret mammograms, and only approximately 30% of mammograms are interpreted by breast imaging specialists. Of radiologists who reported that breast imaging was their primary specialty, only 21% took a fellowship in the field (much lower than for other subspecialties), 59% spent > or = 50% of their clinical work time in the specialty, 82% interpret > or = 2,000 mammograms annually, and only 11% (also well below other subspecialties) report that the main subspecialty society (the Society of Breast Imaging) is one of the two most important professional organizations for them. On average, breast imaging specialists, like other radiologists, report that their workload is about as heavy as desired. Their level of enjoyment of radiology does not differ significantly from average.

CONCLUSION

Breast imaging appears not to be as strongly organized to raise awareness of and support for its problems as are other subspecialties. Although others find evidence of likely future problems, breast imaging specialists are not currently overworked or less satisfied in their profession than other radiologists, despite relatively low revenue generation and a particularly high risk of a malpractice lawsuit.

A Portrait of Pediatric Radiologists in the United States

OBJECTIVE

In recognition of the importance of pediatric radiology and the apparent shortage of radiologists in the field, the purpose of this study was to provide an extensive and detailed portrait of pediatric radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample survey that achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compare information about pediatric radiologists with that for other radiologists.

RESULTS

Approximately 3% of radiologists, some 800-900 physicians, are pediatric radiologists. Depending on how pediatric radiologist is defined, two thirds to three quarters of them spend 70% or more of their clinical work time doing pediatric radiology. Unlike other radiologists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corresponding reduction in income) than desire an increase in workload. Pediatric radiologists who spend 70% or more of their clinical work time in their field are older than radiologists in general (average age, 55 vs 51 years), and the fraction of pediatric radiologists younger than 45 years is lower than for other subspecialists ( approximately 20% vs 37%). Pediatric radiologists are disproportionately women (one third or more, depending on definition, are women, vs 19% for other subspecialists and 15% for nonsubspecialists), hospital-based, in academic practices (approximately half vs one fifth for other subspecialists), and in the main cities of large metropolitan areas.

CONCLUSION

A shortage of pediatric radiologists exists and is likely to intensify. Access to pediatric radiologists is probably a problem except for children in large metropolitan areas who connect readily to academic hospitals. Means to overcome these problems need to be actively sought.

A portrait of interventional radiologists in the United States

OBJECTIVE

In recognition of the emergence of interventional radiology as an important "new component of...radiology," the objective of our study was to provide an extensive and detailed portrait of interventional radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that oversampled interventionalists and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compared information about interventionalists with that for other radiologists.

RESULTS

Depending on the definition of who is an interventionalist, 8.5-11.5% of radiologists are interventionalists. By most definitions, only slightly under half of interventionalists spend 70% or more of their clinical work time performing interventional procedures. Interventionalists work, on average, 56-58 hr weekly, a few hours longer than other radiologists. The average interventionalist performs procedures in five of the seven categories of procedures into which we divided interventional radiology, compared with one or two categories for other radiologists. The average interventionalist performs procedures in five of the seven broad categories (such as MRI, CT, and nuclear medicine) into which we divided all of radiology, much the same breadth of practice as other subspecialists and also as nonsubspecialists.

CONCLUSION

Interventionalists have become a sizable group within radiology. They are in some ways like other radiologists and in other ways different, but they do not spend as much of their time in their subspecialty as some assume and, overall, are not as different.

Radiation oncology career decision variables for graduating trainees seeking positions in 2003–2004

PURPOSE

Radiation oncology trainees must consider an array of variables when deciding upon an academic or private practice career path. This prospective evaluation of the 2004 graduating radiation oncology trainees, evaluates such variables and provides additional descriptive data.

METHODS

A survey that included 15 questions (one subjective, eleven categorical, and 3 continuous variables) was mailed to the 144 graduating radiation oncology trainees in United States programs in January of 2004. Questions were designed to gather information regarding factors that may have influenced career path choices. The responses were anonymous, and no identifying information was sought. Survey data were collated and analyzed for differences in both categorical and continuous variables as they related to choice of academic or private practice career path.

RESULTS

Sixty seven (47%) of the surveys were returned. Forty-five percent of respondents indicated pursuit of an academic career. All respondents participated in research during training with 73% participating in research publication authorship. Post graduate year-3 was the median in which career path was chosen, and 20% thought that a fellowship position was "perhaps" necessary to secure an academic position. Thirty percent of the respondents revealed that the timing of the American Board of Radiology examination influenced their career path decision. Eighteen variables were offered as possibly influencing career path choice within the survey, and the top five identified by those seeking an academic path were: (1) colleagues, (2) clinical research, (3) teaching, (4) geography, (5) and support staff. For those seeking private practice, the top choices were: (1) lifestyle, (2) practice environment, (3) patient care, (4) geography, (5) colleagues. Female gender (p = 0.064), oral meeting presentation (p = 0.053), and international meeting presentation (p = 0.066) were the variables most significantly associated with pursuing an academic career path. The following variables were ranked significantly differently in hierarchy (p < 0.05) by those seeking an academic versus private practice path with respect to having influence on the career decision: lifestyle, income, case-mix, autonomy, ability to sub-specialize, basic research, clinical research, teaching, patient care, board structure, practice environment, and mentoring.

CONCLUSION

These data offer descriptive information regarding variables that lead to radiation oncology trainee career path decisions. Such information may be of use in modification of training programs to meet future personnel and programmatic needs within the specialty.

Special report: results of the 2000–2002 association of residents in radiation oncology (arro) surveys

Between 2000 and 2002, the Association of Residents in Radiation Oncology (ARRO) conducted its 18th, 19th, and 20th annual surveys of all residents training in radiation oncology in the United States. This report summarizes these results. The demographic characteristics of residents in training between 2000 and 2002 are detailed, as are issues regarding the quality of training and career choices of residents entering practice.

Characteristics of mixed diagnostic radiology-radiation oncology practices

OBJECTIVE

Our objectives were to describe the characteristics of "mixed practices"-that is, practices performing both diagnostic radiology and radiation oncology services-and to compare mixed practices with multiradiologist diagnostic radiology-only practices.

MATERIALS AND METHODS

In 1999, the American College of Radiology surveyed 970 practices by mail, using a 65-item questionnaire. A response rate of 66% was achieved. Responses were weighted such that they were representative of all the radiology practices in the United States. The estimates cited in this article were primarily drawn from this 1999 survey.

RESULTS

Mixed practices were nearly evenly divided between large (area population, > or = 1 million) and small metropolitan areas (area population, from 50,000 to 1 million). We found that 63% of mixed practices were nonacademic private practices; 27% were academic. Approximately 50% contained 15 or more members. Mixed practices were predominantly owned by members of the practice and predominantly served both hospitals and nonhospital settings. At least 90% of mixed practices performed mammography, imaging-guided breast biopsy, sonography, and nuclear medicine. We found that compared with multiradiologist diagnostic radiology-only practices, mixed practices were larger and were more likely to be academic, to serve both hospital and nonhospital settings, and to perform interventional and nuclear medicine procedures.

CONCLUSION

The characteristics of a mixed practice differ from those of a multiradiologist diagnostic radiology-only practice.

Basic characteristics of radiology practices: results from the American College of Radiology's 1999 survey

OBJECTIVE

The basic characteristics of radiology practices in the United States are described. We defined radiology practices as diagnostic-radiology-only practices, either solo or multiradiologist practices. Findings were compared with those from other data sources.

MATERIALS AND METHODS

In May 1999, the American College of Radiology surveyed 970 practices by mail using a 65-item questionnaire. A final response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States.

RESULTS

Approximately 4400 radiology practices existed in the country; 39% were located in nonmetropolitan or rural areas. The greatest percentage of practices (85%) was private nonacademic radiology practices. The greatest percentage of practices (43%) served only hospitals. However, solo practices were particularly likely (p < or = 0.01) to serve only nonhospital sites. Of all multiradiologist practices, 87% were completely owned by their members, but approximately two thirds of academic multiradiologist practices had outside owners. Seventy percent of multiradiologist practices interpreted images from outside clinics or groups; these averaged 3.2 outside clinics or groups for which they interpreted images.

CONCLUSION

The basic characteristics of radiology practices in 1999 are described. Good agreement was seen with findings obtained from other data sources.

Data from a professional society placement service as a measure of the employment market for radiation oncologists

PURPOSE

To aid in understanding the employment market for radiation oncologists, we present annual data for 1991 to 2000 from the American College of Radiology's placement service, the Professional Bureau. This data series is twice as long as any previously available. Secondarily, we compare these data with other data on the employment market.

METHODS AND MATERIALS

The trends in job listings, job seekers, and listings per seeker in the Bureau are tabulated and graphed. We calculate correlations and graph relationships between the last of these and measures of the job market calculated from annual surveys.

RESULTS

Bureau data show listings per job seeker declined from 0.53 in 1991 to a nadir of 0.30 in 1995 and then recovered to 1.48 in 2000. Bureau listings and job seekers, each considered separately, show a similar pattern of job market decline and then eventual recovery to better than the 1991 situation. Bureau listings per job seeker correlate 0.895 with a survey-derived index of program directors' perceptions of the job market, but statistical significance is limited (p = 0.04), because very few years of survey data are available.

CONCLUSIONS

The employment market for radiation oncologists weakened in the first half of the 1990s, as had been widely reported; we present the first systematic data showing this. Data from a professional society placement service provide useful and inexpensive information on the employment market.