Subscription-based and open access dermatology journals: the publication model dilemma.

Medical journalism and the dissemination of peer-reviewed research serve to promote and protect the integrity of scholarship. We evaluated the publication models of dermatology journals to provide a snapshot of the current state of publishing. A total of 106 actively-publishing dermatology journals were identified using the SCImago Journal Rankings (SJR) citation database. Journals were classified by publication model (subscription-based and open-access), publishing company, publisher type (commercial, professional society, and university), MEDLINE-indexing status, and SJR indicator. Of these, 65 (61.32%) dermatology journals were subscription-based and 41 (38.68%) were open-access. In addition, 59 (55.66%) journals were indexed in MEDLINE and most were subscription-based (N=51) and published by commercial entities (N=54). MEDLINE-indexing status was significantly different across publisher types (P<0.001), access-types (P<0.001), and the top four publishers (P=0.016). Distribution of SJR indicator was significantly different across publisher types (P<0.001) and access-types (all journals, P=0.001; indexed journals only, P=0.046). More than 91% of MEDLINE-indexed titles were published by commercial entities, and among them, four companies controlled the vast majority. Discontinuation of access to any one of the top publishers in dermatology can significantly and disproportionately impact education and scholarship.

Canadian and American Emergency Radiology Fellowship Websites: An Evaluation of Content.

PURPOSE: The internet is commonly employed by Radiology trainees to investigate and learn about potential fellowship programs. As a new and emerging subspecialty, Emergency Radiology requires strong internet presence and training program website content. This is vital to ensure good exposure of the fellowship programs to inform medical students, radiology trainees, and program directors, highlight unique aspects of a fellowship and raise awareness of the discipline at large. METHODS: To assess the standard and depth of information available online, Canadian and American Radiology fellowship websites were evaluated for content. Thirty-six criteria related to application process and recruitment, departmental structure, incentives, education, and research and clinical training were evaluated for presence or absence. RESULTS: Sixteen Emergency Radiology fellowship program websites were assessed from the United States and Canada for 36 criteria across 5 individual areas; application process and recruitment, departmental structure, incentives, education and research, and clinical training. Overall there was an absence of information found across all 5 areas. In particular areas for improvement were identified in education and research, and incentives both with median values of 12.5% of criteria present. CONCLUSION: Most Emergency Radiology fellowship program websites demonstrate several information deficiencies. This relative lack of comprehensive information represents an actionable opportunity for individual programs and the field to better educate trainees, program directors and the public about the unique training of Emergency Radiologists.

An Evaluation of the Content of Canadian and American Nuclear Medicine Fellowship Websites.

BACKGROUND: Radiology trainees frequently use the Internet to research potential fellowship programs across all subspecialties. For a field like nuclear medicine, which has multiple training pathways, program websites can be an essential resource for potential applicants. This study aimed to analyze the online content of Canadian and American Nuclear Medicine fellowship websites. MATERIALS AND METHODS: The content of all active Canadian and American Nuclear Medicine fellowship websites was evaluated using 26 criteria in the following subdivisions: application, recruitment, education, research, clinical work, and incentives. Fellowships without websites were excluded from the study. Scores were summed per program and compared by geographic region and ranking. RESULTS: A total of 42 active Canadian and American Nuclear Medicine fellowship programs were identified, of which 39 fellowships had dedicated fellowship websites available for the analysis. On average, fellowship websites contained 34.4% (9 ± 3.3) of the 26 criteria. Programs did not score differently on the criteria by geographical distribution (P = .08) nor by ranking (P = .18). CONCLUSION: Most Canadian and American Nuclear Medicine fellowship websites are lacking content relevant to prospective fellows. Addressing inadequacies in online content may support programs to inform and recruit residents into fellowship programs.

Evaluation of Pediatric Radiology Fellowship Website Content in USA and Canada.

PURPOSE: Prospective radiology fellows often rely on the internet to obtain valuable information regarding the application process as well as the unique qualities and aspects of different fellowship programs. The aim of this study was to analyze the content of Accreditation Council for Graduate Medical Education (ACGME) Pediatric Radiology Fellowship websites within the USA and Canadian Accredited Pediatric Radiology Fellowship program websites. METHODS: All active ACGME Pediatric Radiology fellowship websites as of October 2018 were evaluated using 26 criteria in the following domains: application process, recruitment, program structure, education, research, clinical care, and incentives. Fellowships without websites were excluded from the study. Canadian programs were compiled from a list obtained as of October 2018 from the Canadian Association of Radiologists fellowship directory. Each fellowship program was evaluated using the same 26 criteria as the US programs. RESULTS: 45 active ACGME Pediatric Radiology fellowship programs and 9 Canadian programs were identified. 43 of the US fellowships (96%), and 8 of the Canadian fellowships (89%) had dedicated fellowship websites available for analysis. For US data, websites on average contained 8 out of the 26 data points (31%). Whereas, in Canada, websites on average contained 11 out of the 26 data points (41%). CONCLUSION: Most fellowship websites demonstrate several information deficiencies. This presents an actionable opportunity for individual programs to better inform trainees, promote Pediatric Radiology, and attract the highest quality applicants.

An Evaluation of the Content of Canadian Radiology Fellowship Websites.

PURPOSE: Prospective radiology fellows utilize the internet to apply for radiology fellowship programs. The aim of this study was to analyze the online content of Canadian radiology fellowship websites. METHODS: The content of all active Canadian radiology fellowship websites were evaluated using 30 criteria in the following domains: application, recruitment, education and research, clinical work and benefits. Fellowships without websites were excluded from the study. The prevalence of assessed elements was compared to geography and Canadian medical school ranking. RESULTS: We identified 107 active Canadian radiology fellowship programmes, of which 102 university fellowships (95.3%) had dedicated fellowship websites available for analysis. Of these 102 programs, the median score was 13/30 (43.0%). Websites of fellowship programs affiliated with top ranked medical schools contained more of the assessed criteria than middle and lower ranked schools (17.0 vs 13.0 vs 9.0, p < 0.0001)). Geographical difference was identified across Canada with Atlantic and Central Canada fellowship programs having significantly more criteria than Western programs (15.5 vs 16.0 vs 10.0, p < 0.001). CONCLUSIONS: Most Canadian radiology fellowship websites are devoid of content pertinent to prospective radiology fellows. Addressing deficiencies in online content may assist programs to inform and recruit residents into radiology fellowship programs.

Current Clinical Practice Patterns of Self-Identified Interventional Radiologists.

OBJECTIVE: The purpose of this study was to assess patterns of procedural, clinical evaluation and management (E/M), and diagnostic imaging services rendered by self-identified interventional radiologists (IRs) across the United States. MATERIALS AND METHODS: Recent Medicare Physician and Other Supplier Public Use and Physician Compare national downloadable files were linked. IRs were defined as physicians self-identifying interventional radiology as their primary specialty on Medicare claims or as a specialty during Medicare enrollment. The primary outcome measure was percentage of work (in work relative value units [WRVU]) attributed to interventional services (both procedural and E/M) per IR. Secondary outcome measures included sociodemographic factors per interventional WRVU quartile and percentage of E/M service units per IR. Statistical analysis included chi-square and t tests and logistic regression. RESULTS: Overall, 3132 physicians nationally self-identified to Medicare as IRs. The distribution of WRVU attributed to interventional services was strongly bimodal. Procedures and E/M together accounted for ≥ 91% and ≤ 5% of total work for the most and least intervention-oriented quartiles, respectively, but were widely distributed in the middle two quartiles. The most intervention-oriented self-identified IRs were more likely out of medical school ≤ 30 years (odds ratio [OR], 2.5; p < 0.0001), men (OR, 2.2; p < 0.0001), and in academic practice (OR, 4.3; p < 0.0001). E/M accounted for only 1.4% of all billed services. CONCLUSION: Although most self-identified IRs perform both interventional and diagnostic imaging services, the subspecialty distribution is strongly bimodal, one-quarter each focusing ≤ 5% and ≥ 91% of work on interventional services. Despite ongoing emphasis on clinically focused interventional radiology, E/M services remain rarely reported.

Physician Specialty and Radiologist Characteristics Associated with Higher Medicare Patient Complexity.

RATIONALE AND OBJECTIVES: Meaningfully measuring physician outcomes and resource utilization requires appropriate patient risk adjustment. We aimed to assess Medicare patient complexity by physician specialty and to further identify radiologist characteristics associated with higher patient complexity. MATERIALS AND METHODS: The average beneficiary Hierarchical Condition Category (HCC) risk scores (Medicare's preferred measure of clinical complexity) were identified for all physicians using 2014 Medicare claims data. HCC scores were compared among physician specialties and further stratified for radiologists based on a range of characteristics. Univariable and multivariable analyses were performed. RESULTS: Of 549,194 physicians across 54 specialties, the mean HCC risk score was 1.62 ± 0.75. Of the 54 specialties, interventional radiology ranked 4th (2.60 ± 1.29), nuclear medicine ranked 16th (1.87 ± 0.45), and diagnostic radiology ranked 21st (1.75 ± 0.61). Among 31,175 radiologists, risk scores were higher (P < 0.001) for those with teaching (2.03 ± 0.74) vs nonteaching affiliations (1.72 ± 0.61), practice size ≥100 (1.94 ± 0.70) vs ≤9 (1.59 ± 0.79) members, urban (1.79 ± 0.69) vs rural (1.67 ± 0.59) practices, and subspecialized (1.85 ± 0.81) vs generalized (1.68 ± 0.42) practice patterns. Among noninterventional radiology subspecialties, patient complexity was highest for cardiothoracic (2.09 ± 0.57) and lowest for breast (1.08 ± 0.32) imagers. At multivariable analysis, a teaching affiliation was the strongest independent predictor of patient complexity for both interventional (ß = +0.23, P = 0.005) and noninterventional radiologists (ß = +0.21, P < 0.001). CONCLUSIONS: Radiologists on average serve more clinically complex Medicare patients than most physicians nationally. However, patient complexity varies considerably among radiologists and is particularly high for those with teaching affiliations and interventional radiologists. With patient complexity increasingly recognized as a central predictor of clinical outcomes and resource utilization, ongoing insights into complexity measures may assist radiologists navigating emerging risk-based payment models.

Factors Influencing List Prices for Radiologists' Services.

PURPOSE: To identify factors associated with list price variation for radiologists' services. METHODS: The 2014 Medicare Physician and Other Supplier Public Use File was used to identify submitted charges ("list prices") and payments for radiologists' services (ie, not hospital service charges). Charge-to-payment ratios were computed for individual radiologists as a measure of excess charges. Numerous radiologist-level factors identifiable using publicly available data sets were explored. RESULTS: Among 26,715 radiologists nationally, the mean charge-to-payment ratio was 4.2 ± 2.0. A greater charge-to-payment ratio was most strongly predicted for those serving higher-complexity patients (ratio ranging from 3.8 ± 1.8 to 4.1 ± 1.6 for radiologists in the first through third quartiles in terms of patient complexity, compared with a ratio of 4.8 ± 2.8 for radiologists in the highest quartile in terms of patient complexity). A higher charge-to-payment ratio was also observed among those with, rather than without, a teaching institutional affiliation (4.7 ± 2.8 versus 4.0 ± 1.8, respectively) and among subspecialists rather than generalists (4.4 ± 2.5 versus 3.9 ± 1.5, respectively). Among subspecialties, charge-to-payment ratios ranged from 3.3 ± 1.3 (breast imaging) to 5.7 ± 4.1 (interventional radiology). Charge-to-payment ratios showed weak inverse correlations with total service volume (r = -0.13) and total payments (r = -0.11). CONCLUSION: Distinct from hospital prices and historically considered arbitrary, higher charges for radiologists' services demonstrate consistent patterns of variation and are most strongly seen for those serving higher complexity patients. As price transparency initiatives expand, radiologists should be aware of how and why their list prices compare with local and national benchmarks.

Knowledge of the Costs of Diagnostic Imaging: A Survey of Physician Trainees at a Large Academic Medical Center.

PURPOSE: To study the awareness of postgraduate physician trainees across a variety of specialties regarding the costs of common imaging examinations. METHODS: During early 2016, we conducted an online survey of all 1,238 physicians enrolled in internships, residencies, and fellowships at a large academic medical center. Respondents were asked to estimate Medicare national average total allowable fees for five commonly performed examinations: two-view chest radiograph, contrast-enhanced CT abdomen and pelvis, unenhanced MRI lumbar spine, complete abdominal ultrasound, and unenhanced CT brain. Responses within ±25% of published amounts were deemed correct. Respondents were also asked about specialty, postgraduate year of training, previous radiology education, and estimated number of imaging examinations ordered per week. RESULTS: A total of 381 of 1,238 trainees returned complete surveys (30.8%). Across all five examinations, only 5.7% (109/1,905) of responses were within the correct ±25% range. A total of 76.4% (291/381) of all respondents incorrectly estimated every examination's cost. Estimation accuracy was not associated with number of imaging examinations ordered per week or year of training. There was no significant difference in cost estimation accuracy between those who participated in medical school radiology electives and those who did not (P = .14). Only 17.5% of trainees considered their imaging cost knowledge adequate. Overall, 75.3% desire integration of cost data into clinical decision support and/or computerized physician order entry systems. CONCLUSIONS: Postgraduate physician trainees across all disciplines demonstrate limited awareness of the costs of commonly ordered imaging examinations. Targeted medical school education and integration of imaging cost information into clinical decision support / computerized physician order entry systems seems indicated.

How Much Do Common Imaging Studies Cost? A Nationwide Survey of Radiology Trainees.

OBJECTIVE: The objective of this study was to gauge the knowledge of radiology trainees regarding the costs of common imaging services and to assess their perceptions of current relevant education. SUBJECTS AND METHODS: During mid-2014, an online survey of 5325 U.S. residents and fellows who were members of the American College of Radiology was conducted. Respondents were asked to provide information about year of training, relevant advanced degrees (e.g., Master of Business Administration or Master of Public Health), number of hours of formal education in health care economics provided annually by their training program, self-perception of knowledge of health care economics, and desire to learn more about the costs of imaging. Respondents were asked to estimate Medicare-allowable fees for five commonly performed imaging examinations: two-view chest radiography, contrast-enhanced CT of the abdomen and pelvis, unenhanced MRI of the lumbar spine, complete abdominal ultrasound, and unenhanced CT of the brain. Responses within ± 25% of published allowable amounts in the Medicare fee schedule were deemed correct. RESULTS: A total of 1066 of 5325 trainees (20.0%) returned surveys that were sufficiently complete for analysis. Only 17.1% of all responses were correct; 65.3% of responses were overestimations of actual costs, and 17.6% were underestimations. Almost half of the trainees (45.1%) incorrectly estimated the cost of every examination. Overall, knowledge of costs of examinations did not improve with advancing years of training, hours of education in health care economics, or attainment of a relevant advanced degree. Only 9.3% of trainees considered their knowledge of imaging costs to be adequate. An overwhelming 89.7% of trainees desired more focused education. CONCLUSION: Radiology trainees have limited knowledge of the costs of commonly performed imaging studies. Effective training program curricula currently appear to be lacking. Targeted education and integration of cost information into clinical decision support tools are probably warranted.

The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department.

INTRODUCTION: Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters. MATERIAL AND METHODS: We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions. RESULTS: Our investigation consisted of 117 patients; 75 males of average age 41 (±12) years and 42 females of average age 44 (±17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87 (±71) minutes. Average effective radiation dose for a facial CT was 2.4 (±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209. CONCLUSION: Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs.

The diagnostic utility of rib series in assessing rib fractures.

Rib series rarely add information to the posteroanterior (PA) film for the diagnosis of rib fractures. In this investigation, we evaluated the utility of rib X-rays using turnaround time (TAT), radiation exposure, and cost-efficiency as the key parameters. This investigation was conducted from January 2008 to December 2012. We included patients who had rib series performed for suspected rib fractures. TAT for patients was calculated from the time exam was ordered by the emergency department (ED) physician/staff to time the report was finalized by the attending radiologist. Effective radiation dose for rib series was calculated as a summation of radiation dose from the standard rib series images for each patient. Cost-efficiency was determined based on the number of interventions that took place as a result of a complicated study. Our investigation consisted of 422 patients, 208 females aged (57 ± 20.8) and 214 males aged (48 ± 17.3). A total of 74(17.5 %) abnormal findings were noted, out of which only 1(0.23 %) underwent management change. The mean turnaround time for patients undergoing rib series had a value of 133.5 (±129.8) min as opposed to a single chest PA of 61.8(± 64) min. Average effective radiation dose for a rib series was 0.105 (±0.04) mSv, whereas average effective radiation dose of a single chest PA was 0.02 mSv. Dedicated rib series has a low-yield diagnostic value as it pertains to management change. The overall impact on patient care based on our findings is small when compared to the risks associated with prolonged TAT, repeated exposure to radiation, and extensive medical costs.