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Breast imagers find that work expands, but pay and time don’t

Breast imagers find that work expands, but pay and time don’t

Women's imaging is moving and shifting in seemingly predictable ways, but that doesn't mean practice has become easier.

Three prominent practitioners in women's imaging told Diagnostic Imaging they are becoming primary care physicians, though they can't bill for that. Dr. Marcela Bohm- Velez, president of Weinstein Imaging Associates and a clinical assistant professor of radiology at the University of Pittsburgh; Dr. Ellen Mendelson, a professor of radiology and director of breast imaging at Northwestern University; and Dr. Stamatia Destounis, an attending radiologist at Elizabeth Wende Breast Care in Rochester, NY, all said they are doing more than just reading mammograms.

While also getting more involved with their patients' lives by acting as primary care docs, the radiologists are constantly “on call.” All three practitioners provide patients with their cell phone numbers and thus receive calls after work, on weekends—basically all the time.

It's hard to keep up with it all because of so much to juggle, so there is a backlog of work. Obviously, some sites are worse than others, but many women have to wait longer and longer for their screening mammograms. Below, the radiologists talk about how practice has shifted.

SHIFT CHANGE

Q: How has practice changed for you?

Destounis: We spend half an hour talking to these women—examining them, doing the ultrasound, and performing biopsies. But there's no billing for doing all this work. I've become their primary care doctor. They're calling me instead of the doctor when their infection is back, or if they're allergic to the antibiotic that I put them on for their abscess. I've become their primary care physician, but I'm a radiologist. I communicate with their husbands and themselves when they have a diagnosis of cancer. I'm speaking to them more than any of their doctors, but I'm still treated like a lab, and I cannot bill for services that I'm performing, which is examining them and taking care of them.

Mendelson: The direct patient care and the management of patients is our responsibility. And in many places— Northwestern is one—we go from screening all the way through histologic diagnosis. So there is really an important relationship that you forge with the patients. When you have high volume, you have a lot of phone calls to make, people to see, lots of talking, lots of advising, many questions, and that's primary care.

Bohm-Velez: Patients come to me because they want that special attention [they get from a private practice]. I do the mammogram, I do the ultrasound. I talk to them. When I go in the room nowadays, they will ask me questions about something like, “I take hormones, do you think I should take hormones? When do you think I should do my densitometry?” All these issues have to do with women's health, so I need to be educated about that. I try to keep on top of what's going on with the new hormone replacement therapy. Patients ask me about it. I go into the room, and they say, “Look, I'm taking arimidix, it's causing me joint pain, what do you think I should do?” The gynecologists are probably overwhelmed.

Not only am I referring the doctors, the breast surgeons, where to do the MRI, where to do the studies, but I also recommend how to follow the women. I call them with the results as soon as they come back. I recommend the breast surgeon, so they think of me as a primary doctor. The problem is when you spend that much time, there's also only so much you can do.

Q: Are you experiencing a backlog of work? Bohm-Velez: No. If you call and say I have a palpable mass, you will be seen that day. That's just our philosophy. Mendelson: Asymptomatic women may have to wait a few months for a screening mammogram, but for an urgent or emergent problem, they can be seen promptly that day or within the next two days. There is a backlog, but it's not specifically ours.

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