why do x rays cost so much
A: I have had two clients ask me this recently. Modern, digital x-ray systems offer many advantages over the outdated systems of yesteryear, but they are indeed expensive. В Letвs have a look at why. First, there is the cost for the x-ray machine, digital receiver, and computer with specialized software to run the operation. В After installation expenses, a complete digital DR system costs around $120,000. В Letвs assume the veterinarian takes out a five-year commercial loan at 6% interest to pay for the equipment. В Thatвs $27,840 in loan payments each year. This expensive equipment comes with expensive maintenance and service contracts that typically run over $5,000 per year. В In addition, large digital image files require off-site backup and storage that costs over $2,000 per year. В Assuming a fair market commercial lease and a modestly sized room, the facility lease on the square footage required to house an x-ray unit is roughly $2,100 per year. Personal protective equipment for employees, like lead gowns, and the OSHA-mandated radiation safety badges for each employee cost the typical practice over $1,000 per year. В There is also a state-mandated inspection and calibration that adds about $250 to the annual cost. So, we havenвt taken a single x-ray yet or paid a single employee, but we have over $38,000 in annual cost just to provide the equipment involved. В Letвs assume we x-ray one pet each weekday for all fifty-two weeks of the year. В Thatвs an equipment expense of over $146 per pet. Now, letвs add employee costs. We need at least one Licensed Veterinary Technician (or doctor) and one assistant to properly restrain the pet and take the x-rays.
В Letвs use a conservative figure of $25 labor cost for those folks. В Now letвs discuss the cost of doctors to interpret the films. The American Animal Hospital Association advocates having a board-certified radiologist review all diagnostic x-rays. Many practices, like ours, have made this a standard of care. Admittedly, this is a step that can be skipped, but general practice veterinarians are not trained to see many of the subtleties that can be seen by a radiologist. Radiologists spend four to five years after veterinary school getting additional training, pass a board exam, maintain annual continuing education in radiology, and read thousands of x-rays every year. Digital technology allows us to get a radiologistвs opinion within hours for only $60 more. If weвre going to invest in getting x-rays, letвs be sure the pet benefits from all the information present on those images. Are you keeping track? В Weвre now up to $231 in actual costs before we have paid your veterinarian to review the x-rays, read the radiologist report, come up with a plan, and communicate it to you. В We also havenвt paid the practice overhead expenses yet (record keeping, licenses, utilities, continuing education, bank fees, taxes, etc. ). It is cheaper to use older equipment that has already been paid off and/or to skip the radiologist interpretation. However, I can tell you from personal experience that modern equipment and a specialistвs expertise get so much better information (with less radiation exposure to pets) that we used to get with a streaky piece of film on a light viewer.
Often this better information leads to more effective, efficient, and economical care. Modern digital x-ray technology and electronic specialist consultations are just one example of how veterinary medicine is offering pets higher quality care than ever before. However, it also demonstrates how better care often comes with a higher cost. With x-rays, as in everything else, if you want the best care for your pets you should prepare long before your pet needs to have medical attention. A good pet health insurance policy could reduce the ownerвs out of pocket expense for x-rays from $250 to $25. Without this preparation, an owner might seek a low-cost veterinarian to take self-interpreted, old style films for $150, thinking they are saving money. In reality, they end up paying more than the owner with insurance and get less by cutting corners.
Everyone seems to be basing their reasons here mostly on the costs of the machines. I would assert that the biggest chunk of the money goes to the radiologists who read and interpret the images. The machines do cost a lot and have a fairly limited use but it s no where near the cost of staffing. CT and MRI machines - ~$300,000 - $2,000,000+ (MRI on the higher end, CT on the lower end but there will be cross over) Ultrasound machines - ~$200,000 X-ray machines - ~$50,000 - $150,000+ Plus the cost of setting up the premises. There are very specific standards that must be followed with respect to radiation shielding in different rooms. The amount of radiation transmitted through the walls must be measured at several points to ensure that people outside the room aren t unknowingly being irradiated as they are walking by.
MRI machines require very expensive setups with shielding from radio waves (faraday cages? I don t know a lot about this but I ve been told they re quite costly). Then there is the upkeep on all the machines. It is mostly in the form of service contracts from the vendors but even those are very costly. Machines must be replaced at certain intervals. Where I live, a CT machine cannot be older than 10 years so that needs to be factored into the costing. The cost of implementing a PACS system so that images can be archived and transmitted electronically is also expensive. The programs associated with radiology are quite expensive as is the viewing equipment and printing equipment because of the exact standards required. But as I mentioned that all pales when compared to the cost of radiologists. Where I live a consultant radiologist can expect to earn at least $500,000 a year. I know of quite a few that are earning well over the $1 million mark without owning their own practice or anything special. They also get very good benefits (10 weeks annual leave, 2 weeks conference leave, education expenses etc) in exchange for the huge amount of training they undergo. It is at a minimum 12 years of study and work before you can be a radiologist. There are also expenses from your education as well as the normal doctor expenses once you get there. Still I think most people would be pretty happy to have the job. Also, it s not just one doctor that you need to have. Depending on size you have several radiologists.
The company I work for has 50+ radiologists, and about 900 other staff. The cost of staffing these other people to take the images (radiographers, sonographers etc who are all at least degree qualified themselves), administration staff, nurses etc is not insignificant. People have mentioned a lot about outsourcing the reporting to overseas which is definitely done in some cases, however there is a lot of concern over how to ensure the standard of care is maintained. I don t know a lot about it other than to say it does happen but it s not as widely used as might be thought, and even when it is its more often to cover night time patients or holidays. After having painted radiology clinics as barely making ends meet, I can also say that they are very profitable businesses even with the amount they pay their doctors. And this is all coming from an Australian perspective where we charge a fraction of what the US charges. Last year I saw a receipt someone posted where they were charged $7,800 for a CT abdomen from a US emergency department. That is just off the charts fucking crazy. We would charge between $220 and $450 for the same scan, reported and with a set of printed films and a DVD of the images. (different people pay different amounts. Government funded healthcare pays less than a private insurance company) So if we can charge 10% of what they charge and still make a healthy profit, someone in the US is lining their pockets and should be stopped. Also, I m fairly sure radiologists in the US don t earn as much as I quoted ours getting paid so thats even less reason to be charging like that.
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