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Radiology Versus The Primary Care Shortage

February 22, 2012
Written by: , Filed in: Diagnostic Imaging, Practice Management
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The lure of radiology (and other medical specialties) may undermine the Patient Protection and Affordable Care Act, according to a Washington Post article by health policy reporter Sarah Kliff.

The article’s headline is: “Success of health reform hinges on hiring 30,000 primary care doctors by 2015.” Here’s the core of its analysis:

Decades of research have confirmed that more specialists leads to more specialty care, which leads to a more expensive system. Now, with the passage of the Affordable Care Act, tens of millions of previously uninsured Americans will be looking for a primary-care doctor. It is no exaggeration to say that the success of the health-care law rests on young doctors choosing to do something that is not in their economic self-interest.

The article, published earlier this month, says of primary-care residents: “At the end of residency, they can stay in primary care and earn $29.58 an hour. Or they can specialize and make $74.45. Over a lifetime, a medical student who specializes can expect to earn $3.5 million more.”

Doctors are not the only component of the health-care system for which specialization is more economically attractive, Kliff writes:

A radiologist will earn a hospital $193 in Medicare reimbursements every hour, a primary-care doctor brings in $101, according to an analysis done for a congressional watchdog agency.

If the health-care overhaul succeeds in adding 32 million Americans to the ranks of those with health insurance, the article says, we will need 29,800 more primary-care providers by 2015.

Perhaps surprisingly, supply is increasing to meet demand, the article says: “The number of American medical students matching into primary-care residencies jumped 20 percent between 2009 and 2011, according to the Association of American Medical Colleges.”

Here’s a question the article doesn’t address: when all those 29,800 new primary-care doctors order tests for all those 32 million newly insured Americans, who’s going to read the images?

As more than one survey has warned, there’s also a shortage of radiologists that projects to worsen with the retirement of the baby boom generation. According to the Medscape Radiology Compensation Report for 2011:

Those who live in small cities and in small towns or rural areas report wages as much as $30,000 higher than their urban counterparts. The gap may reflect difficulty in attracting specialists to rural areas. The shortage of radiologists across the United States hits small communities especially hard.

Health care is a complex, interconnected system. Yes, we definitely need more primary-care physicians. But, especially as America ages, we’re going to need more people in the entire field, period.

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How will health-care changes affect the training of radiologic technologists? The American Society of Radiologic Technologists surveyed radiologic science teachers as a start at answering that question. For details, see our Facebook page.

Related seminar: Radiology Review

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