Don't DOGE My Radiology
How would you respond if you were asked for ‘five bullet points of what you accomplished last week’?
It happens far more often than not. Folks who use social media encounter other people’s reactions to news items in advance of hearing the news itself.
So it was that I saw a posting about VA rads having to come up with “5 bullet points of what you accomplished last week” before I saw anything else about DOGE’s mass email to federal employees.
Read any actual news about it rather than commentary, and you will see that it wasn’t really a matter of drilling down on who is doing what. It was more of a “proof of life” exercise, and there is a rabbit hole I could go down (but won’t here and now) on why that is worthwhile.
Proof of life aside, working radiologists do a lot. We are way closer to being boastful than shy about it. Give us a chance to sound off on our workload, and you might have difficulty shutting us up again. Our biggest challenge might be limiting ourselves to a tidy, short list, and not cramming multiple items into each bullet point.
For instance, I think that most of us would immediately condense the number of cases we would read into a single line. Nowadays, a week’s worth for me would be about 300. Back when my worklists were filled with XR and US, I would break a thousand. It would probably be malicious compliance to make a thousand-point list itemizing each study, but any given patient whose health care is at stake might well consider his or her individual case an “accomplishment.”
A rad could reasonably compartmentalize by modality, venue, or time frame. Bullet point #1 might be “Covered all XR from the ER during day shift,” #2 might pertain to ultrasounds from the ER, etc. Covering call counts for at least one “accomplishment” all on its own.
One might get bored with parsing cases and delve into other typical things we do like protocoling scans, QA, attending/leading meetings or conferences. The social media posting included a few other tongue-in-cheek suggestions like “waited on hold to talk to clinicians,” and “did CME, which is irrelevant to rads but mandated anyway.”
I did specify “working” radiologists. There are others out there who might have a harder time accounting for themselves, and judging from the social media posting, the VA is a popular location for them. This is not necessarily by choice. Some rads told of getting hassled for being too productive in the VA, making others look bad. They adapted by producing less.
That is all hearsay, at least coming from me and the social media comments. The last time I saw VA radiology firsthand was back in my residency. The VA was across the street, and we did occasional rotations over there. Compared with our main hospital, it was a sleepwalk of a workday, and some of our attendings loved covering the place for that reason.
I imagined that changing in the subsequent 20+ years, but per the social media post, it remains the status quo. Folks regard it as a job for those who want a slower pace (“semi-retired” with a non-competitive salary) or can’t get a better gig. Still, even under those circumstances, it seems like one should be able to claim five reasonable accomplishments from any given week.
Between that, the radiologist shortage, and the low VA salary, one might reasonably consider it a safe haven from the meat cleavers of DOGE. Other radiological venues pose fatter, juicier targets for cost cutting, right?
Don’t look at any of us, rads might squawk en masse. You have been cutting our reimbursements for longer than many (if not most) currently practicing rads have been in the field. An AI search engine tells me that “a 10-year analysis from 2011 to 2021 revealed a combined mean reduction of 44.4%” across a number of imaging study types. I mention my source because I am not vetting it. Feel free to find your own statistics if you like.
Corroborating that is a different slice of my own long-term experience from another recent social media post that talked about hospitals subsidizing rad groups when low reimbursement rates make it difficult to sustain the practice. That dovetailed with stuff I had recently heard about how a lot of jobs are using such subsidies to pay above per-RVU rates lest rads go elsewhere.
I felt motivated to comment that I was old enough to remember, for instance back at the millennium’s beginning, when radiology had sufficient RVUs to be an income generator. We lived in a constant state of low level resentment that our surplus got siphoned away so the hospital could subsidize other money-losing departments. All those reimbursement cuts have turned us from donors into recipients. Are you inspired to pause here for a “hurrah?”
The thing about stuff like DOGE is that everybody thinks they have got a good case for why their sacred cattle should be spared the ax. Granted, “you’ve been whittling at me with that ax for decades already” sounds like a pretty compelling exemption to me, but I am a radiologist myself and thus biased.
Meanwhile, I think part of the reason DOGE enjoys the popularity it has is that government seems to be one of the few sectors that has steadily grown over the years. It is actually part of their financial model. Use your budget as fully as you can, even waste stuff at the year’s end if you have to, or you will be cut. But if you spend every penny and make a decent song-n-dance to the right politicos, you will get an increase. The rest of us live in a different world, and kind of resent it.
That resentment increases dramatically if you happen to live/work in a sector, which is particularly heavily regulated by said ever-growing entities. Their growth often seems to be squarely aimed at impairing your livelihood, requiring you to “do more with less” in endlessly multiplying ways.
The Reading Room Podcast: Emerging Trends in the Radiology Workforce
February 11th 2022Richard Duszak, MD, and Mina Makary, MD, discuss a number of issues, ranging from demographic trends and NPRPs to physician burnout and medical student recruitment, that figure to impact the radiology workforce now and in the near future.
