Are radiologists' attitudes changing post-pandemic? How can practices attract them in this evolving environment? And is there a reason for hope, despite AI’s clear arrival?
Noted radiologist Tarang Patel, MD, podcaster and Banner University Medical Center physician, discussed all of these questions at RBMA’s closing keynote session, “…a Word with Bob LIVE,” on April 16 in Las Vegas.
What follows is an edited transcript of their conversation, which has been condensed and edited lightly for clarity.
Bob Still: My next guest is Dr. Tarang Patel. He's a diagnostic radiologist who advocates for physicians and patients by removing as many of the third-party intermediaries possible in our healthcare system. Dr. Patel is creator of the 'Doctor Money Matters' podcast, which helps educate physicians on the financial issues that they deal with as busy working professionals. He also created the American Radiologist Facebook group, the largest social media community for radiologists to discuss issues related to their profession. He is currently working with other radiologists to develop solutions to help hospitals and imaging centers with their staffing needs due to the unprecedented rise in imaging volumes in this time of increasing radiologist and technologist shortages. Please welcome to the stage, Dr. Tarang Patel.
So, Tarang, I love the 'Doctor Money Matters' podcast. When I was in the business of recruiting physicians to move to Lancaster, Pennsylvania, the first thing I would say to the doctor’s spouse is 'whatever the realtor is showing you, buy lower.' Is that a good observation?
Patel: Yes, we're always targeted to spend here, buy this house, buy this car, buy this investment. That was my whole thing [with starting the podcast] ... to help educate doctors about trying to avoid some of those pitfalls.
Bob: How'd that go?
Patel: Well, we are still dealing with some of those issues. I keep talking about some of the the questionable investment opportunities we are offered.
Still: Yes, it is a challenge. I mean, doctors make pretty good money. They're not plumbers and bankers and realtors, but…
Patel: In a lot of towns, traditionally, doctors were among the higher earners and the more accessible people with a little bit different income stream than maybe the average person in the community. And so, they're kind of the targets for the local stockbroker or wealth manager, the insurance salesmen and things like that. Listen we all need those people. But historically, not everyone has had the best interests of doctors in mind, and we were doing fine. But then we keep talking about these Medicare reimbursement cuts. Now that margin gets 3% less every year. That's why we need people to keep telling us, ‘OK, be careful about this or that.'
Still: When you said stockbrokers, this is a true story. I got a call one day in my office when I was managing a radiology group, and we had a radiation oncologist involved with a local stockbroker. One of the physician’s wives asked him to call me about investing in environmentally friendly, green companies. And I didn't really want to talk to the guy. And so I said, ‘You know, it's those bad companies and all those chemicals that keep the radiation oncologist in business.’ And the guy stopped there. He was like, ‘Oh, well I never thought of that. Well, have a good day,’ and he never called me back.
So let's get to the 30,000-foot level. What do you think most practices are looking for today?
Patel: Practices are looking for radiologists. I think you guys know there is a shortage nationally, a higher level of turnover, retirements, but also just people in general who work less. During the pandemic, priorities shifted. People started realizing, 'I can work remotely, I can work a little bit less and maybe my lifestyle won't change significantly.' And so, that combined with the explosion in imaging volume has made work for those who are still working more stressful. That's accelerating their desire to maybe cut back a little bit. So practices, I think, are all looking for radiologists. What radiologists are looking for are solutions to help them work more efficiently, and to have a better lifestyle and get as many unnecessary nonradiology things off their plate as possible.
"I am much more hopeful now than I was even two years ago because I do see the undercurrent of all this annoyance in the community of radiologists than I kind of monitor. There's so much more pushback now."
- Tarang Patel, MD, radiologist and podcaster
Still: You became a radiologist at about the time people were talking about artificial intelligence replacing members of the specialty. What were your thoughts back then around that and what do you think now as we go forward with AI and the advances that come with it?
Patel: When I first came out of medical school, many of you are probably familiar with CAD, computer aided detection in breast imaging, and it was touted as a massive technology upgrade. But it pissed off a lot of the radiologists because it helped filter out all these false negatives or false positives that showed up. And so, radiologists tend to be skeptical. Now, things are a little bit different. I think you're speaking of Dr. Geoffrey Hinton, the University of Toronto professor who made a comment eight years ago that, by 2021, radiologists were supposed to be replaced, but we're still here.
Still: You're still here.
Patel: That's not to say that AI is not coming. We do know that AI is coming as evidenced by the vendors, as evidenced by a lot of the dollars that are being put into AI companies. It's the question of, I don't know if I'm worried as a radiologist as much as I'm worried as a human. If radiology is ripe to be taken over, then virtually almost all knowledge professions are.
Bob: Sure.
Patel: And so, I think that's the scale that we should be worried about. To a degree, in the short run, radiology is going to benefit significantly from AI. The technologies that I've seen both here, at RSNA, some of the other demos, they're going to take away some of the work that is burdensome to us—measuring everything that we need to or making all of the callbacks and just a lot of stuff that we find irritating on a day-to-day basis. It will help us with that. And I hope that that part will actually make our lives more efficient, our careers longer, and more enjoyable. So I actually am positive about AI.
Bob: That's brilliant. Everyone here who is managing a practice or doing consulting are going to go back home and face the reality that they are recruiting. What's your advice? What's going to make somebody move to Hattiesburg, Mississippi, versus Lancaster, Pennsylvania? You're managing a practice. What would you say to a radiologist coming out of training?
Patel: So, what I would say to the radiologists coming out of training is a lot of them tend to be congregated in the big academic centers in the Northeast or in Chicago or Texas. If you want a scope of medicine that's different and a little bit more broad, look beyond those ivory towers. You're going to get to do and practice in a way, if you go to a smaller town, that maybe is a throwback a little bit in terms of, not the technology, but the way that the lifestyle for the physician feels.
Not quite as fast-paced as in somewhere like the Northeast. I trained in New York City. It's very much a high-stress environment
Still: Pretty much. It stresses me out when I go visit my son in Brooklyn and have to pay $15 for a Slurpee.
Patel: Absolutely, and I think patients appreciate their physician more in some of these smaller towns.
Still: That's interesting. Good to know. With lifestyle, most radiologists can be flexible enough because you can read out of your home office, right? Is shareholder status still a big deal for radiologists as it was when I was managing?
Patel: I think a lot of people now who are in training have been kind of conditioned to think that they're just going to be employees. And I don't think that's a good thing, but that's what they've been conditioned to believe. They've basically been trained by people who are employees of massive health systems or university medical centers. And that's mostly the people who graduated a few years ago. That's what they felt. Whether they're an employee of a university health system, a government hospital, private equity practice, they don't feel like they have a voice. Lack of a sense of ownership, that's one of the reasons you see a lot of radiologists who are going from jump to jump to jump. And basically they're saying, 'I have a job offer from Practice A who is offering me this amount. What can you Practice B offer me? $2 more an RVU? What's the difference to me?'
Still: They're exercising the transfer portal.
Patel: Right, exactly.
Still: I find that interesting because when I was managing a practice, it's not too long ago, it was expected you're going to be here for 25 years. I used to say, ‘why should doctors be any different than their friends who have an MBA and are going from company to company?’ It seems like we are there now.
Patel: Yes, but again, in business and in sports, that's one thing. This is not good for patient care because if you have no ownership in a practice, are you really going to sit there and do the other work to make the practice better?
Still: The practice-building work?
Patel: The practice building. Am I going to do the [quality assurance] that's above and beyond what I'm supposed to do so that my patients who live in the same community are getting the care that they need on a day-to-day basis? Whereas if I'm reading remotely—I read remotely occasionally, too—but I'm less invested. Then I can also be like, ‘well, if this practice isn't meeting my needs right now, then I'll just move to another one.
Still: Yes, that's really interesting. I find some of the biggest stressors with practices now and radiologists are what I call ‘faceless third party issues.’
Patel: So many other entities have come into healthcare from when I was growing up, or when you were managing organizations. Your practice was just the doctors, the patients, and very few of the other intermediaries. I don't know if many of you have seen the growth curve that goes around in terms of healthcare administrators versus patients versus costs versus insurance company profits versus reimbursement for physicians. The physician growth curve goes up slightly. All the other ones except for physician reimbursement, they go up dramatically. And the physician reimbursement curve continues to come down. So, I think all those basic intermediaries—whether they're insurance companies, whether they're private equity firms, whether they're 15 other layers of administrators in between you and your CEO and the hospital—none of those are really, in most physicians minds, providing vital services. I'm not here to say that they are or not. There are certainly some that that do, but it does take away from some of the relationships we used to have with the people who were immediately impacted by our work.
Still: Well, we used to have relationships in Pennsylvania with the Medicare intermediary and with the big insurers. There was an actual physician relations rep who would come to our meetings and answer questions. It seems like it's all gone.
Patel: Yes, now it's algorithm based. It's going to get denied. You're going to get denied and then if you call back or appeal, maybe you'll get paid, and that's part of their plan.
Still: I try to explain to people who are not involved with healthcare or physician billing that there's a lot of organizations that are getting a nickel for every 20 cents. There was an article recently just last week in the New York Times about MultiPlan the organization, which I'm sure you all know, and I read the article. I go, 'well, yeah, they've been doing that for years. Taking money out of the system or out of patients’ pockets.' Some thoughts on how we can fight that?
Patel: To me, shining light on it with these articles is great. Ultimately, who gets angry? It's the patient and who gets the blame? It's the doctor's office because that's where you live. You can't call—well, you can call your insurance company after going through 15 layers of buttons that you press to get a hold of someone, but they don't care. So ultimately, the patient suffers, the doctors get blamed and how do we get rid of it? I don't know. I think software, AI, those kind of things are going to start being used by physicians in their tool belt to help us root out some of these companies doing that and maybe improve our accuracy in fighting off prior authorizations and things like that.
Still: Sure.
Patel: And then just in general, technology in terms of building practices has become a little bit more cost effective so that people who are starting out right now—tougher in radiology still—but in other fields are able to do that at a lower cost point than they were maybe five to 10 years ago.
Still: Yes, and AI may be a way to reach that lower cost point. That's great. I said this earlier in the conference that hope is a practice. Are you hopeful?
Patel: I am much more hopeful now than I was even two years ago because I do see the undercurrent of all this annoyance in the community of radiologists than I kind of monitor. There's so much more pushback now and willingness to learn about what those difficulties are and how we can overcome them than there was just a few years ago. In the past, there was more of a relegation of, ‘I guess this is how it's going to be.’ So, I think we are in a positive term. I do see five years from now, radiologists are going to be in a very much more positive setting than they are in right now. Other than we are all working very hard right now, but I think their attitude is improving.
Still: I share your hope. Thank you for joining us
Patel: Thank you so much.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.