Radiologists still reading more lower extremity MRIs than nonradiologists, especially on weekends

Nonradiologists such as orthopedic surgeons are interpreting a growing number of musculoskeletal imaging examinations. According to a new study published in the American Journal of Roentgenology, however, radiologists are still performing a lion’s share of the work, including a much higher percentage of weekend reads and clinically complex patients. 

The authors studied national Medicare data for more than 125,000 lower extremity MRI exams interpreted from 2012 to 2014. Overall, they found that 94 percent of those exams were performed on weekdays. Of those weekday interpretations, radiologists handled more than 83 percent while nonradiologists took on the rest. Meanwhile, radiologists read more than 99 percent of weekend exams.  

“In our Medicare fee-for-service patient cohort, radiologists provided greater than 90 percent of weekend services for lower extremity MRI, which represented a greater than 10 percent relative increase from their percentage for weekday work,” wrote lead author Paige Sharp, MD, department of radiology and imaging sciences at the Emory University School of Medicine in Atlanta, and colleagues. “In contrast, relative volumes of weekend interpretation work by competing nonradiologists decreased 55 percent compared with their weekday volumes. These observations support the anecdotal experiences of some radiologists who have perceived discrepancies in referrals for services based on day of week.”

The authors also noted that, “for reasons not entirely clear,” Tuesdays were the busiest day of the week for both radiologists and nonradiologists. Also, nonradiologists saw their volume drop by more than 20 percent on Fridays, “suggesting an extended-weekend workflow phenomenon.”

Radiologists also interpreted more than 90 percent of the most clinically complex patients, adding further evidence to the argument that radiologists are providing significant value the specialty may not be getting properly rewarded for.

“As quality measures become increasingly implemented as the basis of physician payments, researchers will increasingly have opportunities to identify novel metrics to promote patient access and value,” the authors wrote. “Our work shows that radiologists disproportionately perform lower extremity MRI services more often on less desirable workdays, on patients in more acute settings, and for the most complex patients, thus providing value to those patients in ways not apparent in existing traditional quality measures. As new payment metrics are devised, temporal, acuity, and complexity parameters should be considered as tools to help promote societal imperatives of promoting increased patient access and minimizing disparities.”