Numbers in a Vacuum

May 8, 2015

There’s more behind the numbers.

More than occasionally, a glance at popular online radiology forums will yield at least one discussion thread about payment rates for different study types. Not what’s being billed by hospitals or imaging centers, not what CMS or insurers are offering…rather, what individual radiologists who are being compensated per interpreted study are receiving. This tends to refer to teleradiologists, since most others don’t have their income broken down as “piecework.”

Fortunately, there tends to be a chorus of responses from other rads advising/asking that numbers such as these not be bandied about on public forums, for they can do no good. One way or another, they will be used against the best interests of most radiologists who actually read studies for a living (as opposed to, shall we say, more bureaucratic types).

Unfortunately, this chorus is more often than not ignored, and numbers proceed to flow anyway. Rarely do these numbers prompt applause or even lukewarm-positive sentiment…because most of the responding radiologists find the numbers unconscionably low.

This is because the numbers, considered in a context-free vacuum, are quite a bit lower than many (including nonphysicians) would think merited by such professional work. Someone who has been and/or will be a patient in need of an X-ray to diagnose, characterize, or monitor significant disease, no matter how much he bellyaches about a copay at the time of service, is liable to wonder just what quality of service he can hope to receive when he hears that a physician is given all of $5 to read his X-ray.

Getting back to the point, however: These between-radiologist communications often wind up with radiologist A expressing anything from dismay to disdain to disgust as to how much radiologist B is getting per study. Or A, B, and half the remaining alphabet form an online echo-chamber about how hypothetical radiologist Z, working in a telerad situation none of them have personally experienced, is being a fool, a sell-out, or worse, by reading studies for far less than any of them claim they would.

Discussing these compensation numbers in a vacuum, devoid of other detail, tends to oversimplify things. (Which can be an innocent error, or an intentional maneuver to stack the deck in favor of a preconceived agenda.) Yes, if you and I are both reading the same mix of studies, sitting in identical offices with identical equipment and having identical other responsibilities, and I wind up being paid half per study of what you are, I agree that I am probably getting a raw deal.

Stepping outside of the vacuum and recognizing some of the surrounding factors, the comparison becomes less cut-and-dried. Suppose I am given better hardware and software with which to work, while you have semi-obsolete, buggy stuff and a voice-recognition “solution” that creates more problems than it solves? Suppose I have a robust staff to handle things like getting clinicians on the horn when necessary, whereas you have to personally pick up the phone, track people down, and wait forever on hold in the process?[[{"type":"media","view_mode":"media_crop","fid":"35001","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_168948545807","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3727","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 177px; width: 250px; float: right;","title":"©In Tune/Shutterstock.com","typeof":"foaf:Image"}}]]

Suppose, in brief, that I wind up twice as productive as you due to these efficiencies, and the cost of providing them to me results in my employer having to lower my per-study rate to half of what you are getting. Net effect being that I read twice as many studies as you, yet wind up with the same paycheck. Is that a raw deal, if I prefer not having the software/hardware/logistical headaches you constantly endure?

Take it a step further: Suppose my employer is able to provide me these efficiencies at a lower cost, and thus has to take less of a cut from my reimbursement. If I’m still able to read twice as many cases as you, but now getting 60, 70% of what you get per case…suddenly, my lower per case rate is not only buying me a smoother, less hassle-ridden workday, but a net financial gain.

Such things are hard to objectively quantify, and highly variable on an individual basis. One radiologist might see his productivity soar from such support, whereas another might read cases at the same pace no matter what you do (or fail to do) for him. So now, in addition to the complexity of thinking about these numbers outside of their tidy little vacuum, one must also consider the YMMV (your mileage may vary) factor.

Nevertheless, as the saying goes, “Nature abhors a vacuum.” Seekers of true-to-life, useful data and conclusions to be drawn therefrom would be wise to emulate it.