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After yet another a bad case of blogger’s block, I found this post today in Dr. Flea’s blog. I can’t thank him enough for giving me an idea to write about.

And he deserves another thank you for introducing a great new blogger.

Dr. Flea says…

I have maintained for some time that, in order to make a living today, an MD-level flea in private practice must keep his waiting room and exam rooms full of children who don’t need to be there. That means lots of sick visits. I do not choose to practice this way. The payors reimburse well visits far better than sick visits. Doesn’t it make financial sense to see as many well children as you can? The economics of office practice favor my approach.

The economics of private radiology practice here in India (as I’m sure is the case elsewhere) are governed by two numbers;

• - Average Cases per Day &
• - Average Revenue per Case.

The higher both the numbers are in a radiology practice, the healthier its business. Fairly simple. A Radiology practice’s very existence depends on this.

All Radiologists would agree with me that a significant proportion of the radiological studies that they report are ‘Normals.’

The ‘Normals’ make up the bulk of our practice and we love them as they involve less work. They make up the stuffing in our ‘masala bondas.’ We love defensive medicine. Its good for the radiology practice.

To paraphrase Dr. Flea;

..in order to make a profit, a private radiology practice needs to keep its waiting rooms and its exam rooms filled with people who don’t need to be there.

In the place where I work, we do about 1500 procedures a month, an average of about 30 x-rays; 10 CT scans and 10 Ultrasound scans per day, and we barely break even. We don’t (yet) have an MRI.

I did some number crunching (something that I’m not very good at, as my friends will attest) on our centre’s statistics for the month of July and came up with some rough estimates.

About 50% of the x-rays taken are for the chest and about 35% are for the extremities to rule out fractures in trauma victims. 80% to 90% of these are Normal.

Two-thirds of the CT scans that are done are for the Brain, among which about 50% to 60% are Normals or are scans in which I have reported some insignificant findings like cerebral atrophy or paranasal sinusitis.

60% of the ultrasound scans are for the abdomen, among which about 50% are pure ‘Normals’ or have some insignificant findings such as enlarged Prostate or a Fatty Liver or small renal cysts. 25% of the scans are routine antenatals, the vast majority of which are normal.

I found that by and large, the body CT scans (for the chest and abdomen) and CT angiograms have very few normals. So is the case with ultrasound scans for small parts (thyroid, breast, scrotum) and colour Doppler vascular studies.

In business terms, this is not so good. The more numerous procedures for which there are a high proportion of ‘Normals’ are the ones in which the Average per case revenue is low. They do not generate as much revenue as do the less often performed, more specialized procedures with a lower proportion of ‘Normals.’

Hmmm…

We need to figure out a way to get our referring practitioners into ordering more of the high-revenue radiological procedures.

And we need to start an MRI service, where the average per case returns are higher.

The one question which will not find a place here would be ‘Is this Good Radiology?’