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

Interventional Radiology Private Practice Patterns

Private practice interventional radiology (IR) in the US takes many forms - from specialty coverage withing traditional diagnostic radiology (DR) models and hybrid IR/DR practices, to multispecialty groups and independent IR practitioners. The purpose of this article is to understand the value each of these current IR models offer and predict their future viability.

Abdominal imaging and patient education resources: enhancing the radiologist-patient relationship through improved communication

INTRODUCTION

The relative ease of Internet access and its seemingly endless amount of information creates opportunities for Americans to research medical diseases, diagnoses, and treatment plans. Our objective is quantitative evaluation of the readability level of patient education websites, written for the lay public, pertaining to common radiologic diagnostic test, and radiologic diagnoses specific to abdominal imaging.

METHODS

In October 2015, 10 search terms were entered in the Google search engine, and the top 10 links for each term were collected and independently examined for their readability level using 10 well-validated quantitative readability scales. Search terms included CT abdomen, MRI abdomen, MRI enterography, ultrasound abdomen, X-ray abdomen, cholecystitis, diverticulitis, hepatitis, inflammatory bowel disease, and pancreatitis. Websites not written exclusively for patients were excluded from the analysis.

RESULTS

As a group, the 100 articles were assessed at an 11.7 grade level. Only 2% (2/100) were written at the National Institutes of Health (NIH), and American Medical Association (AMA) suggested 3rd to 7th grade level to meet the 8th grade average reading level in the United States. In fact, 49% were written at a level that required a high school education or higher (greater than 12th grade).

CONCLUSIONS

With websites like radiologyinfo.org, generating over a million visitors a month, it is that clear there is a public interest in learning about radiology. However, given the discordance between the level of readability of the majority of the Internet articles and the NIH and AMA guidelines noted in this study on abdominal imaging readability, it is likely that many readers do not fully benefit from these resources on abdominal imaging.

Are we failing to communicate? Internet-based patient education materials and radiation safety

INTRODUCTION

Patients frequently turn to the Internet when seeking answers to healthcare related inquiries including questions about the effects of radiation when undergoing radiologic studies. We investigate the readability of online patient education materials concerning radiation safety from multiple Internet resources.

METHODS

Patient education material regarding radiation safety was downloaded from 8 different websites encompassing: (1) the Centers for Disease Control and Prevention, (2) the Environmental Protection Agency, (3) the European Society of Radiology, (4) the Food and Drug Administration, (5) the Mayo Clinic, (6) MedlinePlus, (7) the Nuclear Regulatory Commission, and (8) the Society of Pediatric Radiology. From these 8 resources, a total of 45 articles were analyzed for their level of readability using 10 different readability scales.

RESULTS

The 45 articles had a level of readability ranging from 9.4 to the 17.2 grade level. Only 3/45 (6.7%) were written below the 10th grade level. No statistical difference was seen between the readability level of the 8 different websites.

CONCLUSIONS

All 45 articles from all 8 websites failed to meet the recommendations set forth by the National Institutes of Health and American Medical Association that patient education resources be written between the 3rd and 7th grade level. Rewriting the patient education resources on radiation safety from each of these 8 websites would help many consumers of healthcare information adequately comprehend such material.

Color Doppler sonography in obstetrics and gynecology

This review aims to provide the reader with an overview of the present and future clinical applications in color Doppler sonography for the evaluation of vascularity and blood flow within the uterus (both gravid and nongravid), ovaries, fetus and placenta. The clinical use of color Doppler sonography has been demonstrated within many organ systems. Color Doppler sonography has become an integral part of cardiovascular imaging. Significant improvements have recently occurred, improving the visualization and evaluation of intra-organ vascularity, resulting from enhancements in delineation of tissue detail through electronic compounding and harmonics, as well as enhancements in signal processing of frequency- and/or amplitude-based color Doppler sonography. Spatial representation of vascularity can be improved by utilizing 3D and 4D (live 3D) processing. Greater sensitivity of color Doppler sonography to macro- and microvascular flow has provided improved anatomic and physiologic assessment throughout pregnancy and for pelvic organs. The potential use of contrast enhancement is also mentioned as a means to further differentiate benign from malignant ovarian lesions. The rapid development of these new sonographic techniques will continue to enlarge the scope of clinical applications in a variety of obstetric and gynecologic disorders.

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.

Buy-sell options for radiology: what works and why

Buy-sell agreements for shareholders entering and leaving a radiology practice are different from those commonly used in other business endeavors. This paper explores the reasons for these differences, focusing on the culture of radiology and its unique influence on the buy-sell process. Buy-sell methodologies commonly used in most business transactions are described, and basic principles that influence these methodologies are discussed. The reasons these traditional methods are not applicable to most radiology groups are explored in depth. The paper concludes with a presentation of several workable buy-sell options for radiology practices. The strengths and weaknesses of these options are enumerated, so that each group can customize the option that best suits its needs.

The polity of academic medicine: status of faculty governance

How should academic medical departments be governed? Models of governance span a wide spectrum between autocracies, in which important decisions are made by a single individual, to democracies, in which each member enjoys a voice in decision making. Despite the fact that more participatory governance models are the norm in practice settings outside of academia, many academic physicians seem to take an autocratic model more or less for granted. In fact, however, most medical schools and universities do not mandate a governance system that vests authority in a powerful chairperson, and departments frequently enjoy more latitude than they suppose in determining how to govern themselves. Because an organization's effectiveness is powerfully influenced by its governance structure, academic physicians should give serious consideration to this subject, to ensure that academic medicine is well prepared to meet the many challenges now before it.

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.

A comprehensive portrait of teleradiology in radiology practices: results from the American College of Radiology's 1999 Survey

OBJECTIVE

This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared.

MATERIALS AND METHODS

In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses.

RESULTS

Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs.

CONCLUSION

Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.

Types of Procedures Performed by Diagnostic Radiology Practices:Past Patterns and Future Directions

OBJECTIVE

The purpose of our study was to determine the types of imaging procedures performed by diagnostic radiology practices and the patterns and differences related to practice characteristics.

MATERIALS AND METHODS

The American College of Radiology (ACR) surveyed 970 practices by mail, using a 65-item questionnaire, in 1999. A response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. Trends were explored by making comparisons with data from a 1991-1992 ACR study.

RESULTS

Among the types of procedures studied, the highest percentage of multiradiologist diagnostic-radiology-only practices performed mammography (95%) and sonography (94%). (General conventional radiography and fluoroscopy were not studied.) The lowest percentage of these practices performed interventional procedures (69%) and MRI (77%). Solo practices showed less diversity in types of procedures performed than did multiradiologist practices and were a good deal less likely to perform each type of procedure except mammography and sonography. Generally, higher percentages of practices in nonmetropolitan cities or towns and rural practices performed various types of procedures than practices in metropolitan areas. Practice size, types of settings served (hospital or nonhospital), and practice type also influenced the number of types of procedures performed by a practice. The fraction of practices performing CT decreased from 91% to 83% between 1991-1992 and 1999. Percentages for other types of procedures were generally stable over time.

CONCLUSION

Certain practice characteristics play a role in determining the types of imaging procedures a diagnostic radiology practice performs. The decline in the percentage of practices providing CT and the failure during the 1990s of percentages for MRI and interventional radiology to increase from a relatively low base is worrisome. Future analyses based on a subsequent ACR survey will provide further insights into trends.

Financial Ratios in Diagnostic Radiology Practices: Variability and Trends

PURPOSE

To evaluate variation in financial ratios for radiology practices nationwide and trends in these ratios and in payments.

MATERIALS AND METHODS

In 1999, the American College of Radiology surveyed radiology practices by mail. The final response rate was 66%. Weighting was used to make responses representative of all radiology practices in the United States. Self-reported financial ratios (payments, charges, accounts receivable turnover) were analyzed; 449 responses had usable data on these ratios. Comparison with results of a similar 1992 survey and combined analysis with Medicare data on billed charges provided information on trends.

RESULTS

All measures of payment collections declined sharply from 1992 to 1999, with the gross collections rate (revenues as percentage of billed charges) decreasing from 71% to 55%. Average payment for a typical radiology service decreased approximately 4% in dollar terms or approximately 19% in inflation-adjusted terms. In 1999, nonmetropolitan practices appeared to fare better than others. Among insurers, Medicaid stood out as a low and slow payer, but neither managed care nor Medicare had a consistent effect on financial ratios. The gross collections rate varied substantially across geographic areas, as did, in an inverse pattern, the level of billed charges. One-quarter of practices had accounts receivable equal to 90 or more days of billings.

CONCLUSION

The opposing geographic pattern of billed charges and gross collection rate suggests that geographic variation in the latter is driven more by variation in billed charges than by variation in payment levels. Radiologists saw a substantial decrease in the real (inflation-adjusted) value of payment per service during the 1990s. The large fraction of practices with accounts receivable of 90 or more days of billings-a level considered potentially imprudent by financial management advisors-suggests that many practices should improve financial management and that state prompt-payment laws have not had a substantial positive effect.

The Relationship of Managed Care To Business, Professional, and Organizational Aspects of Radiology Practices

OBJECTIVE

We sought to determine the extent of managed care involvement among radiology practices of different types, locations, and sizes; the factors associated with differences in involvement; and the impact of managed care on professional, organizational, financial, and hospital-relations aspects of radiology practices.

MATERIALS AND METHODS

A survey was mailed in 1999 to a sample of 970 radiology practices; completed, usable surveys were returned by 66% of the practices. Three indicators of managed care were used: a practice's percentage of managed care (HMOs plus preferred provider organizations), local area HMO penetration rate, and self-reported perceived effect of managed care.

RESULTS

Percentage of managed care averaged 30% but was 40% for multispecialty groups. It was relatively high in large metropolitan areas, for practices with no hospital activity, and for practices with any owners who were not practice members. The three measures of managed care were only moderately correlated (correlation coefficient, 0.25-0.33). None of the managed care variables had a statistically significant effect on days provided for vacation and continuing medical education, promptness of payment, years required for practice ownership (partnership), and percentage of practice members who were owners. Higher percentage of managed care was associated with higher collection rates, whereas greater perceived impact of managed care had the opposite association. Two thirds of practices belonged to at least one managed care-related organization such as an independent practice association. Most radiology practices reported no involvement in the managed care negotiations of hospitals, which was true even when the hospital's negotiations included the radiologists' fees or when the practice determined its level of involvement.

CONCLUSION

Many negative outcomes most feared by radiologists regarding the effect of managed care have not materialized. Perceptions of practices as to the effect of managed care seem to reflect negative aspects of their general situation, not only realities of managed care.

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.