Doctor Self-Referral: Should You Get That X-Ray or CT Scan?

Reader Comments
Back to blog

How do I begin my paper or is there a web site I need to go under.

Angela G. of LA 3:46PM December 15, 2009

I am a nurse who has worked in many fields of nursing to include, community health, family health, specialist offices, surgical/trauma and most recently as a former senior nurse reviewer for one of the largest advanced imaging management companies. It is my experience that the majority of doctors are honest and good-hearted. They want to do the best they can for their patients. Unfortunately, there are a small number of physicians who put profit before their patients. What is unconscionable to me is the doctor who self refers and orders a chest CT scan for a patient to screen for lung cancer without doing any type of preliminary workup. First of all, CT chest is not recommended for lung cancer screening. Second of all, the amount of radiation exposure is equal to 400 chest xrays. Not to question the authority of the doctor, the patient complies. Shameful!

Terri Richards of CO 11:43PM November 07, 2009

period all I |effects Javascript,

Bdzfjiso of NC 12:17PM October 27, 2009

I believe self referral is A good time saver if the doctor is an honest Doctor . I also believe to save money and keep doctors honest the best bet is to start them on a salary and let them work to free themselves of that limitation. I believe this because of the posts I read here and personal experience.
Patient or customer education is also important except often some will develop symptoms as they learn whitch can even happen to the healthy people.
Doctors need to diagnose patients need to learn about the diagnosis.
Except in my case I found the doctors was over dosing me and would not listen to me because I had to have a therapeutic level and the seizures I was having because of there therapeutic levels was normal or allowed them to sell more drugs except now I do not trust doctors and do not even take aspirin and I am doing good with no seizures for about four years now. I bet drug pushers I mean doctors do not like reading this.
We need medical staff reform
All doctors need to be put on a salary and work to prove they do not have to be salaried
Even if they own their own clinic they can put themselves on a salary and publish it so there patience will have faith in there decisions and have a panel to decide when they go off the salary
Don D. Brock

Don D. Brock of AZ 1:49PM August 30, 2009

I'm a physician myself. When I was in medical school, I worked with a family practitioner who showed me in detail how to maximize income by self-referring for laboratory work and x-rays. So I know this is a real problem. But I've been salaried since finishing my residency program, with no incentive to do testing, imaging, or surgery. I don't want to see ALL doctors tarred for the sins of the few who figured out how to game the system...

Susan Root of NM 4:33PM August 17, 2009

....Is the term that comes to mind when I read this. Who isn't into padding their wallets if possible? I think we as Americans make very poor patients. We place our faith in a system that continues to reach new financial milestones. The bottom line is patient education. Do you know why the physician has ordered the Xray, Scan, Prodecure...etc? If not, why do you not and why are you not asking questions? Make your physician explain his reasons. Often times unneccessary procedures are performed to "cover all the bases". And that in a nutshell is where Self Referral pays off!

Cheryl C of WY 2:01PM August 05, 2009

I don't know how many less CT's or MRI's would be ordered if there were no self referral, but I think it would be about 1/4 to 1/3rd less.
Tort reform would probably end about 1/2 of all studies, combined the two could account for 75% of all studies ordered.
Training at the residency level would be different because of these changes and then even less studies would be ordered by future doc's.
About 50% are ordered so you will not get sued and 25% to 30% for self referral.
End them both. Reform the Tort laws to be more like the military system and de-credential bad docs rather than fine them, and close the Stark loop hole.

TCB of IL 12:30PM August 05, 2009

Thank you for your honesty unknown doctor who wrote his real thoughts on And the truth is...
I know at lot of non-rads just like you that own equipment solo or partnered with a hospital. It is hard to pay for a 2 million dollar MRI and the techs, storage and billing, and the bottom line is you have to pay the bills just to have the MRI on site.
These docs never talk about patient convienence...Never. The topic of profits does come up fome time to time.
In regards to the doc from the multispecialty group....If you are in a multi-specialty group then you profit from the scanner when the funds are distributed at the end of the year. You can say it is indirect, but the money still lands in your pocket.
I honestly think most physicians don't consciously pad the bill, but that darn unconscious mind is always turned on, and always remembers the kids college fund and boat payment.
Self refferal should be on the top of the list for change, not tabled for discussion.

JMB of IL 3:33PM August 04, 2009

The only reason why I, a non-radilogist physician spends millions of dollars to have my own on CT, MRI, PET or PET/CT equipment is to make more money then I already do. I don't say that out of arrogance, it's just a fact.
I refer more to myself to ensure we can cover the costs of owning and operating said equipment. There are the costs of purchase, maintenance, staffing, supplies, etc. I also would like to turn a profit for all my trouble and liability. Therefore i must refer more to myself. How much more do i refer to myslef? I'm not really sure. I guess it might about 3 times the amount I would normally refer to a radiology group.
The fact is, that we all need more money and the current law(s) allow us to make a great deal more then we would normally, so why not? It's leagal.
Since we are not experts in reading we cover our rear by contracting with an out of state radiology group for interpretation.
Owning my own CT, MRI, PET or PET/CT is not a matter of patient convenience or continuity of care, it's a matter of making more money. It's not illegal and we certainly aren't out to harm our patients. We are here to help.
We also own our own lab equipment and ekg equipment.
The goal here is to capture as much of our patients health care money as we can, right here in our center.

Can't tell you of OH 11:19AM August 04, 2009

"It is disgusting the implications that you, and unfortunately our current president, are making towards a profession WITHOUT ANY DAMN EVIDENCE."
Sorry, but the evidence for overutilization of advanced imaging by physicians who own their own scanners has been piling up for 20 years, if you would bother to check the literature. There have been many, many well-designed studies that have examined insurance claim date. Physicians who self-refer order about twice as many scans, on twice as many patients, as physicians with no financial interest.
CT and MRI scanners represent a huge investment. Multi-slice CT scanners run about a million dollars, and an MRI machine runs between $1.5 and $3 Million, including construction of a shielded room. It also costs a LOT of money for cryogens, service contract, preventative maintenance (after the one-year "warranty" expires), physicists, etc. Each scanner has a "break-even" point that is made clear to the physician owners by the hucksters in General Electric, Hitachi, Siemens and other companies that peddle these scanners. I have seen some of these "get rich quick" proposals, and they are sickening. They typically show the gross revenue based on the number of scans performed weekly or monthly.
Want to know why Congress failed to stop this abuse? It turns out that the self-referring doctors formed a PAC that contributes heavily to Contress. Just follow the money.

A Physician of IL 10:32AM August 04, 2009