Cancer Medicine

A 10-month wait for a mammogram?

A small part of me is glad that my inquiries a while back to get a job at Northwestern University in Chicago came to nothing when I read stuff like this on, of all places, Julie Deardorff’s blog:

Next appointment? Sept. 21, 2009

It now takes 10 months to get an appointment for a regular screening mammogram at Northwestern Memorial Hospital, which runs the largest single-site breast center in Illinois. And if that causes you any stress or inconvenience, Northwestern officials are sorry.

“The growing national shortage of radiologists who have advanced training in reading mammograms has had a significant impact on us,” Dean Harrison, president and chief executive officer of Northwestern Memorial HealthCare, said in a three-quarter page apology in the Chicago Tribune.

Doctors usually recommend that women over age 40 get a mammogram every year.

But the people who read the images–breast imaging radiologists–are scarce in part because screening mammography is not historically a high-paying specialty, has been poorly reimbursed and is prone to litigation relative to other imaging procedures, said Dr. Ellen Mendelson, section chief of Northwestern’s breast and women’s imaging department. Consequently, radiologists have turned to other sub-specialties.

This is the worst I’ve heard. The worst it ever got at one institution I worked at was a two or three month’s wait, and where I work now it’s less than a month. However, in certain parts of the country, what’s happening at Northwestern is not far off in many places if things don’t change.

The reason is that reimbursement for routine screening mammography sucks big time. Indeed, most facilities either barely break even on the procedure, and some lose money. They keep doing them because they make it up for biopsies, but liability insurance for mammography facilities and radiologists who read mammography is becoming increasingly onerous. After all, the leading reason for medical malpractice suits against physicians is delay in breast cancer diagnosis, and guess who bears the brunt of these lawsuits? Primary care physicians, gynecologists, and radiologists who do mammography, that’s who. Consequently, finding mammographers to staff breast centers is a serious problem. It’s a problem where I work, and at the facilities where virtually all of my friends and acquaintances who treat breast cancer work. Couple that risk with the low reimbursement for mammography, and it’s no wonder that radiologists no longer find breast imaging to be an attractive specialty.

Many mammography facilities are like that at Northwestern; they’re on the edge, making patients wait months for mammography, and all it would take is the loss of a few personnel to tip them over the edge. The wait might not balloon to ten months, but it wouldn’t be pretty.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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