[greiskul]

> It is also hard to get patients to agree to having tests done at 5am or 9pm, so it's a case of diminishing returns.

In the US? With health care prices as they are? There are people that travel to entirely other countries for access to health. I'm plenty sure lots wouldn't mind at all to have an exam at 9pm if it meant it was way cheaper.

[lostlogin]

New Zealand. The issue is that the reimbursement is the same whenever the scan is done, but staffing costs more at night (so scans kind of need to cost more at night).

Reading what an MRI costs in the US, I do wonder if a trip to NZ for the scan would actually be cheaper.

[haldujai]

I only know 1-2 NZ radiologists but I understand the system there is egregiously underpaid.

Medicare/insurance reimbursement rates for MRI (the professional fee component) are less than Canada (a system I know).

We scan outpatients near 24/7 on some of our magnets in Canada, the ones we don’t are because we don’t have MRI technologists to staff the shifts (the more expensive part as they have unions with labour laws, radiologists can be worked like dogs with no benefits/protections as contractors).

[lostlogin]

I haven’t heard radiologists complain about their pay here, they seem pretty well paid. The techs are paid nicely too, though that will depend on the employer.

I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you?

Doing those hours with outpatients is very impressive, though I hope to never be involved in such things. Weekends are bad enough!

[haldujai]

Just for clarity I don't mean to suggest at all that radiologists aren't paid well-enough (other than in private equity sweatshops but I feel like that's the case for any industry they buy into).

> I’m surely misunderstanding you - you aren’t saying techs cost more than radiologists in Canada are you?

Individually not at all but in aggregate yes. Disbursements to nursing/techs/allied health (who are also the majority of employees to be fair) are somewhere around 60% of hospital expenditures in Ontario (noting physicians are not included in this budget).

It will vary from institution to institution (and union) but probably similar in most places, for MRI my last institution required 3 technologists per magnet (or 5 for 2 magnets) considering break rules, techs also got an after-hours premium so it worked out to something like $90/tech/hour. You'd also have to hire more as techs are employees so they get work-hour limits and time-off requirements (i.e. can't just offer "extra evening shifts" for those who want it, have to grow the pool) so add whatever employee overhead is (30%?).

The radiologist fee depends on the study type and duration but to keep it simple I'd expect to bill $150-300 for an hour worth of MRI scans on average. These get reported the next business day so there's no extra cost from the radiologist perspective and we can tolerate the added volumes so no need to hire (an average radiologist working hard can cover 2-3 magnets worth of cases in realtime).

For other modalities like ultrasound it's an even bigger gap, I'd expect to bill $30-60/technologist-hour worth of work.

[lostlogin]

Thanks for this explanation.

My day job is staffing magnets, and the staffing levels you mention exactly match what I do.

The radiologists struggle to keep up with our output when we do MSK work or horrendous post treatment livers - I think we need you over here.

[haldujai]

I think you meant to say [beautiful] post treatment livers! They're one of my favourite study types to read although everyone else seems to hate them.

MSK joint studies are definitely higher throughput but those are fun too. We would try and schedule "overnight MSK blitzes" q10min to minimize contrast reaction disruptions for the residents on call which would substantially change the financials I quoted. Ontario still has an add-on code for "3D sequence" if you can believe that so knees/shoulders pay a lot for how little effort they take to read.

> The radiologists struggle to keep up with our output

I noticed during fellowship that US radiologists seem to have lower volumes on average. Canadian radiologists are very overworked in my opinion (90+ CTs in an 8 hour shift, daytime MR seat of 40-50 cases is pretty common) which is largely why I left (also weather).

> I think we need you over here.

If you're in a metro with > 1 million people that's above freezing temperature > 6 months of the year and hiring I'm currently in the job market!