Radiology Partners is in the news more (especially now), but here’s an interesting compare/contrast from S&P back in March 2023 looking at RP vs US Radiology (free account required).
From that, an interesting chart for a bird’s eye view:
Note: this chart is almost a year old and predates a lot of recent developments including RP’s proposed recent restructuring and USRS’s launching of its outpatient teleradiology practice Connexia.
Excellent piece on Prenuvo’s whole body scans by Dr. Dhruv Khullar in The New Yorker:
Doctors sometimes use a barnyard analogy to talk about the vast differences between cancers. A tumor can be a turtle, a bird, or a rabbit, depending on its speed and ability to escape; the goal of screening and treatment is to fence the cancer in. Turtles move so slowly that, fence or no, they’ll never make it out. Birds are so flighty that fences are irrelevant; even if you spot them, there’s no real way to stop them. Only the rabbits can actually be fenced in. By some estimates, at least a quarter of cancer diagnoses can be considered overdiagnoses. These tumors are turtles; they never would have left the barn.
South Korea inadvertently illustrated this point when a government program, starting in 1999, offered free screenings for several common cancers. A thyroid-cancer screening wasn’t included, but many patients opted to add one for a fee. Between the early nineties and the early twenty-tens, rates of thyroid cancer soared fifteenfold—a development that would have been worrying, except that death rates from thyroid cancer never rose, and remained very rare. Diagnosing these cancers wasn’t saving lives: almost all were papillary thyroid tumors, which are present in as many as a third of all adults and rarely cause problems. Nonetheless, tens of thousands of South Koreans had their thyroids removed and started taking lifelong hormone supplements. They’d fenced in turtles.
Excellent, accessible illustration of what screening is for and why more isn’t always better. There will always be happy individual narratives of people saved by screening even when, on the whole, a particular screening test is net harmful. Judging a population tool that results in society-wide costs based on individual unaggregated results is a fool’s game.
Quoting a scene from Scrubs, the most accurate medical television show of all time:
In a 2004 episode of the sitcom “Scrubs,” Bob Kelso, the chief of medicine at Sacred Heart Hospital, runs into a fellow-doctor, Perry Cox, in the hallway. “I am considering offering full-body scans here at Sacred Heart,” Kelso says. “What do you think?”
Cox looks appalled. “I think showing perfectly healthy people every harmless imperfection in their body, just to scare them into taking invasive and often pointless tests, is an unholy sin,” he says.
“Does sound a little sketchy ethically, doesn’t it?” Kelso says. “Thanks, Perry.”
It’s feasible there could be a future world where very frequent low-cost whole-body screening is helpful, particularly if the follow-up for turtles was nearly always just more low-cost whole-body screening and not something costly and/or invasive. But today, in our current strained inefficient system with its high costs—and its current players and their financial motives—this is unlikely to be the case.
The Zelotes C18 (aka TRELC Gaming Mouse with 5D Rocker aka ZLOT Vertical Mouse) is a solid very inexpensive productivity and ergonomics upgrade. If you’ve never used a mouse other than whatever’s plugged into the computer already, this currently sells for just $29.
It’s probably the best way to trial a vertical mouse for radiology without breaking the bank. A vertical mouse is like a regular mouse titled slightly on its side. It removes the pronation at the wrist by mimicking a “handshake” position, and many people (myself included) have found it helps with chronic wrist strain. That said, there’s zero data backing up those purported ergonomic benefits, and obviously vertical mice remain very niche. It’s intuitive that the form factor could help, and I think it does help (me), but I think even more strongly that there are probably idiosyncratic and personal preference factors (and placebo?) at play. There’s also a bit of a learning curve, so you need to stick with it for at least a couple of weeks.
The Zelotes is the cheapest vertical mouse that doesn’t suck, and it has enough buttons that it’s useful for everyday PACS functionality no matter where you work. Thanks to on-board memory—after initial setup/configuration at home—it will work on any other computer you plug it into without any software/drivers being installed. While the Logitech MX vertical feels slightly better in the hand, the Zelotes is better suited for most PACS due to its button configuration. It’s also a little smaller, which will help for those with smaller hands (a classic MX complaint is that’s a bit large for smaller hands).
Do I wish it had a few more buttons? Sure. But the 4-way joystick is perfect for window/level presets, and the additional two side buttons, joystick push click (hence “5D” rocker), mouse wheel click, and the extra top button give you several more presets to play with. How you map those buttons will obviously depend on your preferences, your PACS itself, and whether you want to use the mouse for dictation controls or just PACS shortcuts.
Here’s mine for the hospital, where we currently (but not for long!) use GE Centricity:
Recall that I use an off-hand device for the additional important controls (previous/next field, measuring tools, delete, etc) and AutoHotkey to control dictation without a dictaphone.
If you don’t want a rainbow glowing mouse (too much fun for me), the LED can be turned off easily in the settings.
The mouse can house two profiles in its memory at a time. You can save one button on the mouse to toggle between profiles if you need/want to switch between them on the fly. Alternatively, I personally find myself working with different PACS systems on different days, so I fully utilize every button on the mouse and then switch between the two stored profiles in the configuration software on my home computer. It only takes a second.
Gaming:
If you’re not interested in the slightly weird form factor but do want a solid mouse with a great but not overwhelming number of extra buttons for PACS control, try the G604 Lightspeed. It also has on-board memory so that it will work on any workstation after initial setup.
Pretty Cheap with Infinite Buttons:
If you want an inexpensive mouse with a 12-button thumb grid and on-board memory, try the UtechSmart VenusPro. To go totally nuts, you can map the accessory index finger button to a modifier key like ctrl or shift and add a whole layer of additional commands (though how you’ll memorize them and embed them in muscle memory is a serious question).
Conventional:
For a daily driver regular/non-gaming mouse, I think the Logitech MX Master 3 remains the best. It has amazing build quality with a best-in-class scroll wheel and feel for a conventional mouse. With the Logitech Options software installed, you can set up mouse button functions on a per-application basis.
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More mouse and workstation considerations are here.
The American College of Radiology runs a large and presumably quite profitable job forum. (I believe they outsource its management to a third-party company, but it’s on their website, and their branding is all over it.)
And I’m sure the ACR doesn’t want to police the content of that job forum, if nothing else because nitpicking job listings may discourage people from paying for said listings. Outside of the logistics and hassle, there is an obvious financial incentive to look the other way to potentially misleading content.
However.
I don’t see how one can justify allowing Radiology Partners to disingenuously call itself an “independent private practice” on its job postings (other than by just acknowledging the financial conflict that RP is probably the job forum’s largest customer by a wide margin).
I’m not even saying these are bad jobs. Quality is irrelevant here. You are what you are, and pretending you’re not a nationwide private equity conglomerative corporate practice in a job listing for a teleradiology position is only something you do because you don’t want to get filtered out of people’s search queries.
Here are the options for “work setting” they could have picked:
If you believe in your model and are proud of your practice, then why pretend that you are independent when you’re not? Why not just pick “teleradiology” for a tele job? The straightforward explanation is that they know what job applicants want/are searching for, and their ads will perform better if that’s how they’re listed.
All the RP listings I’ve seen—and not just for the direct RP corporate offerings like this but also for their individual groups—describe the work setting as independent private practice.
This seems, at best, duplicitous and disingenuous. The generally accepted meaning of an independent practice is a business owned and operated entirely by its physicians (and not a hospital, health system, or other business/corporate entity). Physicians are the minority owners of Radiology Partners.
It doesn’t matter if one believes that independence or some variety of corporate structure is better (or even if they’re on the whole equal). There are multiple different options, and RP is cynically picking the wrong one.
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Meanwhile, a quick update about that non-independent parent corporate entity, as reported in Radiology Business this week:
S&P said it is placing all Rad Partners’ ratings on CreditWatch with negative implications. This reflects “heightened downside risk,” analysts noted, given the potential that RP might default on its loans or engage in a distressed exchange in 2024.
My crystal ball is as cloudy as ever.
Earlier this month I wrote about Radiology Partners loaning a group money to help shore up radiologist compensation. That happened, but I was also wrong in my estimation of the likelihood of repayment: it turns out RP may be getting some of that money back after all.
The ultimate outcome is still up in the air, but I’ve addended my previous post with an update.
Update 1/11/2024:
The specific practice loan that I referenced as giving rise to this post began earlier in 2023, and this post was months in finalizing. I’d originally intended to publish it in the summer. Since publishing, I’ve since learned that RP’s extra support has briefly paused.
That’s right, at least for a month or two, the group’s compensation reached the threshold that turned off the “advance” from RP. Hospital subsidies saved the day. Note that the loan term itself isn’t over, and after briefly not needing it, the group has since required more gravy.
Ultimately, this suggests that RP may have chosen the loan method for supporting this practice because they had specific reasons to (correctly?) believe that the loan period would be time-limited: It’s obviously better to give some money temporarily in a non-binding fashion to save a group in crisis than to permanently change the contract if you don’t have to.
The real question for the future will be: will the group consistently earn enough in the end to pay back several million dollars of borrowed money, and if so, how long does that take? And/or, does the group fight it? It sounds like what seemed like free money at the time may ultimately be an actual loan, and paying back that advance will therefore constrain compensation going forward unless long-term profits stay below the mark due to increased contractor use, the need to sweeten up internal moonlighting rates, or understaffing requires dropping volumes. Any or all of those things may happen. They are things happening at groups of all stripes across the country.
The future remains uncertain as always—and RP may still never recoup this loan—but this also means that I was wrong in how easily I dismissed the likelihood of RP seeing some of this money back.
This month credit agency Moody’s downgraded Radiology Partners again (surprising exactly no one): the first (and smallest) of its large debt obligations is due in 2024, they currently owe 10x their earnings, and they can only service these debt obligations through refinancing, which is challenging in the current market even before you consider the potentially tenous state of RP’s acquired practices when they reach their 5-year vesting window. It was inevitable.
If you ask RP, they will tell you that all third parties—whether Moody’s or just a random internet troll like myself—don’t understand their business and aren’t privy to the magic happening behind the scenes.
They consistently maintain that they will be able to refinance, though they never publically acknowledge that the most likely refinancing they will achieve is some form of distressed exchange like a debt-to-equity swap that would likely dilute current shareholders (and is considered a bankruptcy equivalent).
Here’s a slide from their big meeting earlier this year:
I know some people in the radiology community think that when the debts come due that RP will go bankrupt and disappear, but that’s simply not going to happen. Depending on how broadly one defines “success,” there’s an excellent chance they’ll be successful. (To wit, Envision emerged from bankruptcy in the hands of its creditors, but it didn’t go anywhere.)
But here is something you haven’t seen in the news but is nonetheless interesting:
Radiology Partners—already dealing with recurrent credit downgrades, cashflow problems, and investor fears—has been offering no-interest loans to some of its practices to shore up compensation.
Note: I’ve heard a similar story independently from several RP radiologists, but I do not know how common the offer has been (I suspect not very). For what it’s worth, I did reach out to RP and Melinda Collins (AVP of Marketing and Communications) on Twitter/X last week without a response. If you’re at RP and want to weigh in on this purported practice, please reach out. If I’m wrong or misleading in any way, I really, really want to know.
To my knowledge, nobody has pressed RP on this issue yet, and it has not been discussed in any public forum other than a brief mention on this site earlier this year in a quotation from a former RP radiologist. Since that time, I heard from multiple sources that at least one practice has taken the offer, hence this post.
So how does this look in practice? Let’s discuss.
I wrote a long post with lots of options for the best personal radiology equipment (and additional posts about using a left-hand device or implementing the magic of AutoHotkey for achieving hands-free dictation and efficiency).
But gosh, all those words!
For the use-with-your-hands part, here are some quick contexts and a single choice for each that you can implement wherever you work:
Mouse:
Off-hand:
Note: I didn’t get into any of this stuff until I became an attending, but looking back, it is insane that I was just using the garbage plugged into the workstation wherever I sat down.
While not everyone wants or needs to go full-on mega nerd with a hands-free setup and a left-hand device (though it’s awesome and I kind of do think everybody should), even residents would benefit from at least an inexpensive gaming/productivity mouse, especially for call when speed matters (it’s also during those night float months that many of us first began to experience repetitive stress injuries from bad ergonomics and inefficient workflows.) Optimizing is a worthy investment of time/energy/money.
Making a compilation list of links to Dr. Lea Alhilali’s excellent neuroradiology “tweetorials” was literally on my to-do list, but now her threads are all collected on Radiopeadia (so I don’t have to).
When I was serving as chair of the Texas Radiological Society’s Young Professional Section, I surveyed practicing radiologists about the transition between training and independent practice. This collection, along with other career advice, is collected on the YPS page of the TRS website.
Here are some highlights from their advice:
Read More →
The UnitedHealthcare vs Radiology Partners lawsuit went to arbitration instead of a jury trial last month. Last week, the arbitration panel ruled in favor of RP and its practice Singleton Associates, awarding them $153.5 million.
United, for its part, says it’s not done, and that there are still unaddressed counterclaims. From that Radiology Business article: “We do not agree that Singleton will recover an award from UnitedHealthcare,” the Minnetonka, Minnesota, company said.