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Santavicca S, Willis MH, Friedberg EB, Hughes DR, Duszak R. Osteopathic Versus Allopathic Radiologist Workforce Characteristics: A Medicare Administrative and Claims Data Analysis. J Am Coll Radiol 2022; 19:997-1005. [PMID: 35931137 DOI: 10.1016/j.jacr.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Radiologist medical school pathways have received little attention in recent workforce investigations. With osteopathic enrollment increasing, we assessed the osteopathic versus allopathic composition of the radiologist workforce. METHODS Linking separate Medicare Doctors and Clinicians Initiative databases and Physician and Other Supplier Files from 2014 through 2019, we assessed (descriptively and using multivariate panel logistic regression modeling) individual and practice characteristics of radiologists who self-reported medical degrees. RESULTS Between 2014 and 2019, as the number of osteopathic radiologists increased 46.0% (4.7% to 6.0% of total radiologist workforce), the number of allopathic radiologists increased 12.1% (representing a relative workforce decrease from 95.3% to 94.0%). For each year since completing training, practicing radiologists were 3.7% less likely to have osteopathic (versus allopathic) degrees (odds ratio [OR] = 0.96 per year, P < .01). Osteopathic radiologists were less likely to work in urban (versus rural) areas (OR = 0.95), and compared with the Midwest, less likely to work in the Northeast (OR = 0.96), South (OR = 0.95), and West (OR = 0.94) (all P < .01). Except for cardiothoracic imaging (OR = 0.78, P = .24), osteopathic radiologists were more likely than allopathic radiologists to practice as general (rather than subspecialty) radiologists (range OR = 0.37 for nuclear medicine to OR = 0.65 for neuroradiology, all P < .01). CONCLUSIONS Osteopathic physicians represent a fast-growing earlier-career component of the radiologist workforce. Compared with allopathic radiologists, they more frequently practice as generalist radiologists, in rural areas, and in the Midwest. Given recent calls for greater general and rural radiology coverage, increasing osteopathic representation in the national radiologist workforce could improve patient access.
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Affiliation(s)
- Stefan Santavicca
- Senior Data Analyst, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Marc H Willis
- Clinical Professor and Associate Chair of Quality Improvement, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Eric B Friedberg
- Associate Professor, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Professor, School of Economics, Director, Health Economics and Analytics Lab (HEAL), Georgia Institute of Technology, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Professor, Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and Chair, Commission on Leadership and Practice Development, American College of Radiology
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Rosenkrantz AB, Fleishon HB, Friedberg EB, Duszak R. Practice Characteristics of the United States General Radiologist Workforce: Most Generalists Work as Multispecialists. Acad Radiol 2020; 27:715-719. [PMID: 32234273 DOI: 10.1016/j.acra.2020.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES While subspecialty radiologists' practice patterns have received recent attention, little is known about the practice patterns of general radiologists. We aim to characterize this group (which represents most US radiologists). MATERIALS AND METHODS US radiologists' individual work efforts were assessed using the 2017 Medicare Provider and Other Supplier Public Use File and a previously validated wRVU-weighted claims-based classification system. Using prior criteria, radiologists without >50% work efforts in a single subspecialty were deemed generalists. For this study, a >25% subspecialty work effort threshold was deemed a subspecialty "focus area," and generalists with ≥2 subspecialty focus areas were deemed "multispecialists." Practice characteristics were summarized using various parameters. RESULTS Among 12,438 radiologists meeting existing claims-based criteria to be deemed generalists, 85.0% had ≥2 subspecialty focus areas of >25% work effort (i.e., multispecialists), 14.6% had one focus area, and 0.4% had no focus area. The fraction of generalists meeting multispecialist criteria was similar across radiologists' years in practice (range 84.7% to 85.4%), academic vs. nonacademic status (84.9% to 86.6%), and practice size (83.3% to 87.0%). Although general radiologist multispecialization varied geographically, a majority were multispecialists in all states (range 57.6% in VT to 93.9% in WY) and percentages were not associated with state-level population density (r = 0.013; p = 0.926). CONCLUSION The large majority of US general radiologists practice as multispecialists, and nearly all have at least one subspecialty focus area. The predominance of general radiologists' multispecialty focus across various practice types and locations supports their role in facilitating patient access to a range of radiologist subspecialties.
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Hassan N, Butler C, DeCou J, Crumb T, Flohr S, Reischman D, Junewick J. Pediatric cervical spine injuries on CT: difference in accuracy of interpretations by pediatric versus non-pediatric radiologists. Emerg Radiol 2019; 27:185-190. [PMID: 31820269 DOI: 10.1007/s10140-019-01743-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/01/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To retrospectively compare the accuracy of interpretation of initial cervical computerized tomography (CCT) by a non-pediatric radiologist (NPR) versus a pediatric radiologist (PR). METHODS IRB approval and consent waiver were granted to review all injured children from 2010 to 2014 in the trauma registry with CT and magnetic resonance imaging (MRI) of the cervical spine. Patients with negative CCT who subsequently had positive MRI from a single institution comprised the study group. Patients with negative CCT and MRI, matched by age, gender, and severity scores, comprised the control group. The CCTs from both groups were initially interpreted at the time of service by a NPR. Subsequently, a single PR with 20 years of experience blinded to clinical/imaging data reinterpreted these CCT examinations. CT interpretations were then compared with MRI results and evaluated for statistical significance using SSPS software. The data analysis utilized summary statistics, two-tailed binomial test, and univariate χ2 test. Significance for all comparisons was assessed at P < 0.05. RESULTS The study group was comprised of the 21 patients with negative CCT and positive MRI. Of the cohort included, 76% (16) were male and 24% (5) were female. The age range was 1 month-17 years, with a mean age of 9.7 years. CCT interpretation by NPR had a specificity of 91.7% (sensitivity 71.2%, positive predictive value 81.3%, and negative predictive value 86.3%) compared with results of MRI. Six of the 21 negative CCTs were interpreted by the PR as positive, mainly craniocervical junction injuries, and confirmed by MRI (28.6%, P < .001 compared with the NPR); no control CCT was interpreted by the PR as positive (sensitivity 100%, positive predictive value 100%, and negative predictive value 58.3%). CONCLUSION In our retrospective study, a pediatric radiologist has improved recognition of pediatric cervical spine injuries on CT compared with non-pediatric radiologist.
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Affiliation(s)
- Nabil Hassan
- Division of Pediatric Critical Care, OSF Healthcare Children's Hospital of Illinois, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA
| | - Chloe Butler
- Mercy Medical Center, P.O. Box 14584, Des Moines, IA, 50306-3584, USA
| | - James DeCou
- Department of Surgery, Helen DeVos Children's Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - Teri Crumb
- Department of Surgery, Helen DeVos Children's Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - Stephanie Flohr
- Department of Surgery, Helen DeVos Children's Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA
| | - Diann Reischman
- Department of Epidemiology, Grand Valley State University, A-1-178 Mackinac Hall, Allendale, MI, 49401, USA
| | - Joseph Junewick
- Advanced Radiology Services PC, Grand Rapids, MI, USA. .,Michigan State University College of Human Medicine, Grand Rapids, MI, USA. .,Department of Radiology, Helen DeVos Children's Hospital, 100 Michigan Street, Grand Rapids, MI, 49503, USA.
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Waite S, Grigorian A, Alexander RG, Macknik SL, Carrasco M, Heeger DJ, Martinez-Conde S. Analysis of Perceptual Expertise in Radiology - Current Knowledge and a New Perspective. Front Hum Neurosci 2019; 13:213. [PMID: 31293407 PMCID: PMC6603246 DOI: 10.3389/fnhum.2019.00213] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/07/2019] [Indexed: 12/14/2022] Open
Abstract
Radiologists rely principally on visual inspection to detect, describe, and classify findings in medical images. As most interpretive errors in radiology are perceptual in nature, understanding the path to radiologic expertise during image analysis is essential to educate future generations of radiologists. We review the perceptual tasks and challenges in radiologic diagnosis, discuss models of radiologic image perception, consider the application of perceptual learning methods in medical training, and suggest a new approach to understanding perceptional expertise. Specific principled enhancements to educational practices in radiology promise to deepen perceptual expertise among radiologists with the goal of improving training and reducing medical error.
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Affiliation(s)
- Stephen Waite
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Arkadij Grigorian
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Robert G. Alexander
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Stephen L. Macknik
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Marisa Carrasco
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - David J. Heeger
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - Susana Martinez-Conde
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
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The added value of a second read by pediatric radiologists for outside skeletal surveys. Pediatr Radiol 2019; 49:203-209. [PMID: 30367201 DOI: 10.1007/s00247-018-4276-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/28/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Fractures are the second most common finding in non-accidental trauma after cutaneous signs. Interpreting skeletal surveys could be challenging as some fractures are subtle and due to anatomical variations that can mimic injuries. OBJECTIVE To determine the effect of a second read by a pediatric radiologist of skeletal surveys for suspected non-accidental trauma initially read at referring hospitals by general radiologists. MATERIALS AND METHODS In 2016 and 2017, we identified all patients referred to our children's hospital with previous surveys performed and read at a community hospital by an outside radiologist. We excluded patients older than 3 years and studies performed at a children's hospital. The surveys were reviewed by a pediatric radiologist with the printed outside report available. Surveys with disagreement between outside read and pediatric radiologist read were reviewed by a second pediatric radiologist. A disagreement in the second read included only definite discrepant findings agreed upon by both pediatric radiologists. The Fisher exact test was performed to compare the ratio of discrepancies between readers in normal and abnormal surveys. RESULTS Two hundred twenty-five surveys were performed (120 male) at 62 referring hospitals, with a mean patient age of 10.5 months (range: 5 days-3 years). The outside read identified fractures in 104/225 (46.2%) surveys. Thirty-seven of the 225 (16.4%) contained discrepancies in interpretation (n=111). Most of these disagreements (29/37, 78.4%) resulted in a significant change in the report. There was a significant (P<0.0001) difference between disagreement rate in outside read negative (4/111, 3.2%) and positive surveys (34/104, 31.7%). The second read identified additional fractures in 22/225 (9.8%) of the surveys and disagreed with first-read fractures in 17/256 (7.6%). Four of 19 (21.1%) classic metaphyseal lesions diagnosed by the outside read were normal variants; 18 classic metaphyseal lesions were missed by the outside read. CONCLUSIONS This study supports second reads by pediatric radiologists of skeletal surveys for non-accidental trauma.
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Bruno MA, Duncan JR, Bierhals AJ, Tappouni R. Overnight Resident versus 24-hour Attending Radiologist Coverage in Academic Medical Centers. Radiology 2018; 289:809-813. [PMID: 30277849 DOI: 10.1148/radiol.2018180690] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Academic medical centers have long relied on radiology residents to provide after-hours coverage, which means that they essentially function with autonomy. In this approach, attending radiologist review of resident interpretations occurs the following morning, often by subspecialist faculty. In recent years, however, this traditional coverage model in academic radiology departments has been challenged by an alternative model, the 24-hour attending radiologist coverage. Proponents of this new model seek to improve patient care after hours by increasing report accuracy and the speed with which the report is finalized. In this article, we review the traditional and the 24-hour attending radiologist coverage models. We summarize previous studies that indicate that resident overnight error rates are sufficiently low so that changing to an overnight attending model may not necessarily provide a meaningful increase in report accuracy. Whereas some centers completely replaced overnight residents, we note that most centers use a hybrid model, and overnight residents work alongside supervising attending radiologists, much as they do during the day. Even in this hybrid model, universal double reading and subspecialist final review, typical features of the traditional autonomous resident coverage model, are generally sacrificed. Because of this, changing from resident coverage to coverage by an attending radiologist that is 24 hours/day, 7 days/week may actually have detrimental effects to patient safety and quality of care provided. Changing to an overnight attending radiologist model may also have negative effects on the quality of radiology resident training, and it significantly increases cost.
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Affiliation(s)
- Michael A Bruno
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
| | - James R Duncan
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
| | - Andrew J Bierhals
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
| | - Rafel Tappouni
- From the Department of Radiology, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, 500 University Dr, H-066, Hershey, PA 17033 (M.A.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.R.D., A.J.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (R.T.)
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Friedberg E, Chong ST, Pyatt RS, Ferrara S, Strong BW, Nicola GN, Bozman R, Duszak R. Unifying the Silos of Subspecialized Radiology: The Essential Role of the General Radiologist. J Am Coll Radiol 2018; 15:1158-1163. [DOI: 10.1016/j.jacr.2018.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
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