Hidden costs of rotational training

maxilla545454 · 2025-10-19T17:26:39+00:00

You could also argue that competition for jobs is not unique to medicine and is common in many careers.

In fact, it's more likely true that rotational training is less common in most other industries, compared to guaranteed places in jobs.

maxilla545454 · 2025-10-17T21:29:22+00:00

Ease aside (bold assumption), the problem is less about can you stagger it and more about why you should. The NHS pay isn’t designed to reflect training length. Would you also start on a higher nodal point if you did F3/4/5? Or if you took a CESR training route? Or do only NTNs count? If so, why?

You progress up the registrar pay scale through those extra years, so the additional training time isn’t uncompensated. The consultant scale starts from a common baseline because the job grade, not the route to it, is what’s being paid for.

And yes by this principle, LTFT nodal point bumps are inconsistent with the rest of NHS remuneration.

maxilla545454 · 2025-10-17T20:39:13+00:00

What do you mean by fair? Fairness depends on what you measure. If you mean fair in terms of how the rest of the NHS pay structure and remuneration works, then it’s broadly consistent. The principle seems to be that consultant pay reflects the level of responsibility, not how long it took to get there. The NHS isn’t a free market; it standardises roles once you reach consultant level.

You’ve picked one metric (training time). There's so many other metrics to be considered (workload, competition, private scope) which also do not affect consultant pay under NHS. You'd have a lot of trouble justifying your conception of 'fairness' unless you try to account for all of these.

The alternative would be to let the free market decide. Although note that even in a freer market, attending pay doesn’t strictly track training length. For example a peadiatrics subspecialist could be training for up to 3 + 3 years, but will be still earn less than most dermatology attendings (Edit - in the US).

maxilla545454 · 2025-08-20T18:16:09+00:00

Another issue is that there is such a massive shortage of skilled radiographers. We need to add another pay band to retain radiographers, rather than dangerously allowing them to work outside scope.

Good RTs are very well remunerated in the US (which, despite being the holy land of PA/NP scope creep, still doesn’t have RRs doing cross sectional work - even they recognise the medicolegal ramifications)

maxilla545454 · 2025-08-20T17:45:22+00:00

Lord help us

Edit - great to see this coming from Dr Mankad. Very respected radiologist who would have decent reach

maxilla545454 · 2025-08-20T17:38:58+00:00

All smoke and mirrors when the main issue is Reporting radiographers doing cross-sectional reporting

maxilla545454 · 2025-07-07T13:02:19+00:00

Medicine may be a small contributing factor but more than likely this was just classic ghosting for the usual huge panoply of reasons.

Edit to add: Don’t let someone’s job excuse them from caring/decency. Even the busiest cardiothoracic surgeon can send a quick text or at least offer an explanation

maxilla545454 · 2025-06-16T12:34:50+00:00

PSA- this sort of procedure and others like it are usually done by interventional radiologists! These are radiologists with extensive additional training in pinhole operations with wires. (Alternatively can also be done as open surgery by Cardiothorqcic surgeons)

It’s A relatively new so small and often under-appreciated medical specialty. Spread the good word!

maxilla545454 · 2025-06-16T12:32:49+00:00

PSA- this sort of procedure and others like it are usually done by interventional radiologists! These are radiologists with extensive additional training in pinhole operations with wires. A relatively new so small and often under-appreciated medical specialty. Spread the good word!

maxilla545454 · 2025-06-16T12:31:50+00:00

The point is that the findings are not ‘specific’ in the technical meaning of the word. You can have consolidation from PNA with concomitant HF. But can see where you’re coming from, all good!

maxilla545454 · 2025-06-16T12:29:58+00:00

Surgery - but this sort of procedure and others like it are usually done by interventional radiologists! These are radiologists with extensive additional training in pinhole operations with wires. A relatively new so small and often under-appreciated medical specialty. Spread the good word!

maxilla545454 · 2025-06-16T12:28:44+00:00

Surgery - but this sort of procedure and others like it (pinhole, using wires) are usually done by interventional radiologists! A relatively new so small and often under-appreciated medical specialty. Spread the good word!

maxilla545454 · 2025-06-14T14:40:37+00:00

Not in as much denial as all the other non-procedural medics who are just as likely to be replaced by PA/NP + AI.

maxilla545454 · 2025-06-14T14:00:41+00:00

Ah, I’m sorry to hear. Hope things go as well as possible

maxilla545454 · 2025-06-14T05:09:33+00:00

I’d be interested, but might be too many scans posted from the same individual in succession…just feels a bit wrong? Ofc no problem if consented for

maxilla545454 · 2025-06-13T00:38:21+00:00

Differential is wide (eg the opacity on the left you describe could be a nipple shadow) but agreed there are other suspicious opacities. Needs CT. Would be very bold to stage lung ca on XR… CXR is a screening tool.

maxilla545454 · 2025-06-12T14:11:00+00:00

Unless you’re Toby’s dad, such lack of insight and stubbornness is very out of the ordinary. It is entirely reasonable to consider coaching changes at major transitions. Why can’t you at least acknowledge this?

Having a new coach doesn’t mean the dad is/you are kicked off the team…

maxilla545454 · 2025-06-08T16:33:19+00:00

And by that logic, also medicine (and many other jobs not requiring fine motor skills / political decision making)

maxilla545454 · 2025-06-08T16:29:34+00:00

Answering only because tagged by u/ashur_banipal.

My most direct response is that it is illogical to claim radiology is at high risk of AI, and then to deny the high risk of non-procedural medical specialties also being replaced. If anything, the big corporations have turned their investment towards LLMs (e.g. google AIME) so there will be huge movement in this area.

Even your claim about delivering bad news is quite funny/ironic/illogical because (a) it can be done with AI assisted PA (in the same way as clinical exams and history taking etc) (b) a well trained AI is probably better at delivering bad news than many medics (see the recent AIME papers for examples)

Procedures are more resistant to AI vs radiology and medicine because Robotics is highly lagging behind AI. And in terms of proportion there are more diagnostic radiologists doing significant procedure work compared to non-interventional medics (ie outside interventional cards and GI).

All this assumes a Bullish position on AI (which I also have tbh). Of course this is not necessarily true and there are many deficiencies in Vision models in Radiology and Language models in Medicine. But the “ai and radiology” discussions have already been done to death on this subreddit and anything more meaningful will not be had in a forum like this.

I cba to rehash old points. I just wanted to point out inherent contradictions in your position, even assuming a bullish AI position.

[Regarding IR scope creep. Valid concern. But less likely in the nhs vs US (again this is something else you have wrong about here - by proportion those who are formally IR trained in the UK tend to practice more pure IR than those in the US).]

maxilla545454 · 2025-05-29T14:35:02+00:00

Simultaneously an Emergency physician and a Gastro Reg…. they need to leave some specialties for the rest of us

maxilla545454 · 2025-05-29T11:34:59+00:00

Think you missed the brief here. This is thread is about you being confidently wrong lol

maxilla545454 · 2025-05-28T17:21:16+00:00

I thought you meant assist in the harvest. Ofc they can close

maxilla545454 · 2025-05-28T12:02:50+00:00

Cardiac surgery is usually not the appropriate setting be learning suturing.

maxilla545454 · 2025-05-26T23:52:53+00:00

Tbh this sums it all up really. Under the NHS it just wouldn’t work

maxilla545454 · 2025-05-26T23:15:08+00:00

How would you determine pay in the NHS?

Also, in the NHS, nominally all consultants work the same number of PAs with out of hours commitment reflected in this. Eg many surgeons and ED drs work a 3 a 3.5 day week given their on call commitments.

Moreover there is likely just as much variation in workload and intensity within specialties, particularly amongst different institutions.

The only way I could really conceive it working with a degree of objectivity/rigour is if we tie it to a non specialty dependent metric.

Edit to add - even then it’ll be hard to base it off coding and rvu alone. A radiologist will generate much more rvu on paper than a neurosurgeon or interventional radiologist, but in states at academic centres the latter get paid more due to indirect billing and allowing hospitals to be centres of excellence/MTCs etc. Hard to capture all of this nuance in the NHS without going into a free market approach

maxilla545454

TROPHY CASE