Physicians

PHYSICIANS: Pity the poor radiologist

They are “frustrated” by Liability and Lifestyle Issues, only 7% them are truly happy—although 70% would do it all over again if they had the chance (more than most other doctors). And only 25% of them make more than $400K a year and 40% have to struggle by on less than $300K.

But pretty clearly these are the good old days for radiologists. Methinks that if they don’t like it now, the average radiologist may be in for a rude shock in the next decade or two, as technology will make their skills increasingly exportable to other cheaper radiologists abroad and replaceable by computers reading images. Of course, they’ll not be quiet in defending their lucrative turf, and demand for imaging will just keep going up, so their future isn’t quite that of the steel worker in the 1980s.

But this is one place to watch in the coming years.

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26 replies »

  1. Bill Clinton to speak at RSNA 2010, fee anonymously paid by whom? RSNA turns into AMA.

  2. im currently a high shool student interested in the study of radiology. i feel intimidated due to the amount of schooling and i dont really know what to expect, do you have any advice for me? it would really be a huge help.

  3. Hi, I have found this interesting discussion with comments related to Radiologist through google search.
    Being a Radiologist, I disagree the statement ‘Pity the poor radiologist’. In fact the other way it is true. I agree that competitions between Radiologists has increased because abrupt increased in number of CT/MRI centers. But there is also increased in number of diagnostic investigations.
    Couple of decade back prescribing CT was quite rare. But now you can see CT, Mammography and MRI have become common tests for the investigating any disease. Also there is increased in the payment of Radiologists.
    I feel everybody should read followng blog by a senior Radiologist with the heading ‘The FUTURE RADIOLOGIST’
    http://www.iradix.in/1658-drrjyadav/258-the-future-radiologist-258.html
    Also there are other blogs/articles written by various Radiologists where you could find reverse trend than what is quoted here.

  4. Some dude is about to join our residency program as PGY 2. He somehow skipped the drug test and did not show up on senior electives after his match. Was junior AOA at NYMC. Go figure!

  5. I have been noticing (down in the Miami/Fort Lauderdale, Florida area) a lot of radio commercials that have radiologists talking about the education process they went through to become a radiologist. I was wondering why they went throught the trouble of advertising, but your posting makes it clear.
    I would say that radiologists are starting to worry about remote radiology services that offer low cost services and the technology increases mentioned above. If less skilled/educated technicians can perform these services from remote locations, then the industry is in for a big change. And considering what the radiologists had to pay for their education, they could be in a bad financial situation.

  6. Great blog post about the future of radiology. In fact, you are totally right about the digitization of radiology images. In fact, because of digitization, the product of image interpretation and images are being commoditized–it is a hot topic this year among radiologists and their societies such as the ACR (American College of Radiology) and was the topic of a keynote address at last years RSNA (Radiologic Society of North America). Teleradiology, WITHIN our own borders, are competing with local groups and as you all know, with competition, price goes down… so radiologist salaries WILL go down and it just won’t go down as fast because of rising volume. But in essence, radiologists will need to work harder. We had a boom in medical imaging with new technology and new toys but now there is always that post-boom correction and post golden years equilibration in economies. The landscape of radiology will change rapidly in the next few years. As a radiologist myself, I admit that the salaries are high now but soon it will change. Congress started deliberating cutting costs for medicaid/care this week–imaging is in its sights. Let’s see how it plays out.
    Steven Chan MD
    Radiologist

  7. Hello,
    I have a position Radiologist position in Kansas, i would like to know if anyone might be interested.

  8. As a radiologist I pity the public who walk into an ER injured or ill and have their films sent to someone without a medical degree overseas.
    I am in my mid thirties, have spent the last 10 years doing residency (6) and medical school (4) , not to mention original research and teaching. This is on top of my Ivy league education which wasn’t cheap. My first year as a MD I made over 20,000 dollars as a resident. I have never surpassed 50,000. Sure one day I will make decent money, but I will also be more prepared to treat patients than anyone outside this country. Clinical doctors always turn to radiology and imaging when they are stumped. We see patients when your doctor doesn’t have a clue…that’s the reality.

  9. I dated a radiologist who made $50K a year in the last year of a fellowship. This person worked about 80+ hours a week for 4 years of residency and another year of fellowship in addition to 4 years of med school and 4 years of undergrad where they were always under the gun in terms of having to perform 100%; no Bs allowed on the ole transcript. Their debt when they were finally done, was about $225,000. This is with a public medical school at in state tuition. No underrepresented group membership, so there was little aid available despite having an impecable academic pedigree. Plus, when you are working that many hours, how can you work some other job? Sure, the last year they were able to moonlight at a handsome wage, but that meant working 36 hours straight without sleep (maybe a nap for an hour or two). Believe you me, they deserve what they earn.
    I don’t pity them. I pity you when your child gets sick or when YOU get sick and have a doctor in India read your xrays or MRI and then transmits the signal 4 thousand miles away. Then, when your attending doc has a question and has to get a hold of this person, they can’t reach them so you end up with a less than optimum result. Or, you have a problem and try to remedy it but have to deal with cross national issues of law. Good luck bud.
    People have a love of schadenfreude because they love to see the wealthy fall. Maybe it’s because they are jealous of their success and somehow feel that they too deserve to be that wealthy or earn that much.
    Just pick up a copy of a radiology journal and try and comprehend what is being said if you think they are overpaid or if you think you deserve to make over $200K a year.

  10. I dated a radiologist who made $50K a year in the last year of a fellowship. This person worked about 80+ hours a week for 4 years of residency and another year of fellowship in addition to 4 years of med school and 4 years of undergrad where they were always under the gun in terms of having to perform 100%; no Bs allowed on the ole transcript. Their debt when they were finally done, was about $225,000. This is with a public medical school at in state tuition. No underrepresented group membership, so there was little aid available despite having an impecable academic pedigree. Plus, when you are working that many hours, how can you work some other job? Sure, the last year they were able to moonlight at a handsome wage, but that meant working 36 hours straight without sleep (maybe a nap for an hour or two). Believe you me, they deserve what they earn.
    I don’t pity them. I pity you when your child gets sick or when YOU get sick and have a doctor in India read your xrays or MRI and then transmits the signal 4 thousand miles away. Then, when your attending doc has a question and has to get a hold of this person, they can’t reach them so you end up with a less than optimum result. Or, you have a problem and try to remedy it but have to deal with cross national issues of law. Good luck bud.
    People have a love of schadenfreude because they love to see the wealthy fall. Maybe it’s because they are jealous of their success and somehow feel that they too deserve to be that wealthy or earn that much.
    Just pick up a copy of a radiology journal and try and comprehend what is being said if you think they are overpaid or if you think you deserve to make over $200K a year.

  11. Disclosure: I’m MS2. I also don’t have to pay for a good deal of my education (generous, wealthy parents).
    We have to ask who ought to be paid for healthcare. Is it the hospital and the people who provide the care? Or is it the corporate insurance companies? Yes, physicians are not poor. But why aren’t they justified about complaining of lowering salaries? After all, medical school tuition is just going up. Most medical school graduates are so in debt that the first thing that they want to do is jump into a specialty that will get them out of debt quickly while providing money to start a family. Many physicians are greedy, but the system doesn’t discourage that. Medical education should be subsidized, and this would justify the lowering of physicians salaries. But currently physicians salaries are being lowered to increase the optimize the efficiency of medicare (which is understandable, to me at least) and to maximize the profits of HMOs/private insurance (which is not understandable— they don’t even provide you care, why should you pay them 20% of every dollar you spend on healthcare).

  12. If anyone thinks that radiologists/or any doctor has it so good, then why don’t you quit your job and go to school for the next 10 years, not be paid, and oh yeah, owe $200K in debt. Then when someone says to you “oh poor you” or “you shouldn’t think about money” see how you feel.
    Why is it that doctors are supposed to be people who can’t care about their financial situation? It’s a double standard no one else would ever endure.

  13. Physicians in general are not crying ‘poor’ with regard to compensation compared to national salaries, however consider the following when an estabished profession is plagued by decreasing reimbursement.
    1. Most physicians enter practice at a delayed age usually in their early 30’s, thus realizing a significant time period of ‘lost’income, not figured into current formulas.
    2. Most physicians carry between $100000-$200000 in debt when starting their income-earning years.
    3. Very few professions demand ‘perfection’ at all times and thus incur the cost and risk of lawsuits, and a tort industry that has significantly increased the overhead and decreased both gross and net income.
    4. Specialist physicians, who generally are reimbursed the highest, log work hours near ‘double’ or even more that the average worker in the US.
    5. Health insurance CEOs can now expect compensation packages in the $100’s of millions and even recently near $1-BILLION. Why isn’t anyone looking at that?
    6. Insured and Medicare patients don’t even directly pay their physicians, their insurance companies reimburse minimally given the overall cost of covering visits and procedures.
    7. Few jobs demand the emotional stress associated with caring for people’s lives, how do you put a cost on that, how does that compare to the ‘stress’ and ‘importance’ of, for example, professional athletes who are compensated in the millions annually?

  14. Hey, My mother is an RN, along with both of my sisters. My Dad is a respiratory therapist/soldier, and my brother a Nuc. Med. Tech. I myself, am an active duty Marine, wanting to go into the medical field, and I was thinking of radiology. Does anyone have any useful info on this? Is it a good field to get into? I was just wondering if I could have an outside opinion. Thanks…

  15. “Pity the Poor Radiologist”, Yes, let’s pity the poor radiologist who has gone through 4 years of medical school, 1 year of internship, and 4 years of residency. Let’s pity the poor radiologist who comes out of medical training with $300,000 in debt to pay back with 4 percent interest loans on 180,000, 90,0000 in debt to private lenders, which is at an adjustable mortgage rate.Let us pity us who have to work 12 workdays straight. Hours at work 7:00 a.m.-7:00 p.m. Let us pity the radiologist who is on the every board committee in the Hospital. Let us pity the poor radiologist who has meetings and meetings after work. Let us pity us who have to attend CME conferences on our vacation time, so we can be up-to-date on all our modalities. Let us pity the radiologist who receives calls all the time to come work on your vacation and your wife’s birthday. Let us pity the radiologist who was working while your wife is giving birth. Luckily, I was able to watch the baby being born, but had to return back to work. Let us pity the radiologist, every chunk of change I get goes to student loans, and you find at the end of the year you only have 200.00 in your checking account.

  16. > When we read about physicians’ incomes, these incomes
    > are most often listed in terms of NET INCOME, while
    > the incomes for the rest of us are listed in terms of
    > GROSS.
    Julia — be a little careful of this. What we think of as our “gross income” usually does not include the value of employment benefits, including a whopping 7.75% payroll tax levied on employers (sometimes more!)
    The doctor’s (or lawyer’s, or engineer’s, or most any self-employed professional) “net income” usually does include all this. Business expenses like an office, business insurance, and so-forth are deducted, but anything else generally flows straight to the owner(s) individually. That’s the “net”.
    Just exactly what counts as a “net” depends on the form of the business: S-Corp, LLC, PC, C-Corp, partnership, or whatever.
    If you want to try to put independent professionals on the same footing as employees, you’ll have to look at the employees’ “Total Compensation” including all payroll taxes, workman’s comp, unemployment insurance, pension contributions, health insurance, life insurance, and the rest, not just what’s on their W-2 at the end of the year. And even then it’ll be a bit of a stretch.
    And keep in mind the independent professional is due in justice the returns to:
    1) the work he does in his trade(doctor, engineer, etc.)
    2) business management
    3) ownership
    t

  17. Matthew:
    I absolutely loved “Pity the Poor Radiologist,” and sincerely hope you are correct in your prediction that these are the “good old days” for radiologists. Enough whining is enough, right?
    Your blog, and others, routinely publish similar findings about doctors and how dissatisfied they are with their financial lot. One such example: On June 29, 2006, in a posting at scienceblogs.com entitled “Doctors Pay: Tell Me Something I Didn’t Already Know” (see http://301url.com/doctorsincomes2), “Orac” writes about a study that suggests that, adjusted for inflation, physicians’ incomes are, by and large, falling. The next three paragraphs — separated by a one-line comment by Orac — are quotes from an article in “The Tennessean,” reporting on the study:
    “Doctors may be well off compared with the bulk of their patients, but a new study says fees physicians get from the government and private insurers aren’t keeping up with inflation. Last week, the Center for Studying Health System Change said net incomes for physicians fell from an average of $180,930 in 1995 to $168,122 in 2003, a decline of about 7 percent, when adjusted for inflation.
    “Medical specialists fared better, the study said. Their in comes slipped an average of 2.1 percent, from $178,840 to $175,011 over the period.”
    “The news,” Orac comments, “is even worse if you happen to be in primary care:”
    “But primary-care physicians — the doctors most people see most often — saw their incomes drop an average of 10.2 percent, from $135,036 to $121,262 a year.”
    Ali, at the time this posting appeared, was obviously a soon-to-be med student. He replied with this comment:
    “As someone applying to med schools right now, believe me, this is on my mind. Part of me wishes I had taken the LSAT or GMAT instead of the MCAT, like so many of my friends. If the looming burden of debt wasn’t so huge, I wouldn’t have any reservations. Maybe more subsidized education or more debt forgiveness programs could help.”
    I find all this very depressing, because it backs up my gut feeling that far too many doctors today are in it, in large part, for the money.
    A recent survey that has been making the rounds online, and is reputed to be from the Employment Policy Foundation, lists the top-paying US incomes overall, with physicians and surgeons being the highest paid, at $147,000, and aircraft pilots (the next in line for top income) at $133,500.
    So, let’s get this straight: Whichever way you look at it, doctors aren’t poor. In fact, just about everyone admits that physicians earn more than the rest of us – certainly more than most of their patients.
    That’s why so many of us feel they are “whining.”
    I am presently doing research for an article on the topic of physicians’ incomes, which I plan to post on my blog/website, http://www.honestmedicine.com/
    In the process of doing my research, I found some information that surprised me: When we read about physicians’ incomes, these incomes are most often listed in terms of NET INCOME, while the incomes for the rest of us are listed in terms of GROSS.
    This means, of course, that doctors are even better paid compared to the rest of us than these surveys suggest.
    For instance, according to a very interesting article on the Center for Studying Health System Change website:
    “Despite the downward trend in real incomes, medicine overall remains one of the most well-paid professions in the United States: At least half of all patient care physicians earned more than $170,000 in 2003, and physician average net income was approximately $203,000. And, although surgical specialists have lost ground to inflation since the mid-1990s, they remain the highest-earning of all physicians: Their average income of $272,000 in 2003 was 29 percent higher than medical specialists and 86 percent higher than primary care physicians.”
    Please see http://www.hschange.com/CONTENT/851/#ib7 for the above quote.
    And the AMA publication, “American Medical News,” reports the exact same (net income) figures in its article, “Physician income not rising as fast as other professional pay,” on July 24/31, 2006 at http://301url.com/amnews
    So why then do doctors feel that they are being shortchanged – even abused — in the income department? For instance, this article from “Medical Economics” at http://301url.com/doctorsincomes starts out with: “The earnings tide may be turning” and uses words such as “meager,” “dismal,” “doldrums” and “losing side” to describe primary care physicians’ incomes.
    As those of you who have read my previous comments on this blog already know, my Dad was a general practitioner in the 1940s through mid-1970s, and even way back then, he thought his fellow doctors were greedy. (See http://301url.com/louschopick). But still, I don’t quite understand why doctors feel so put upon, when they are so well paid. But they do.
    Thanks for your truly wonderful site!
    Julia Schopick
    http://www.honestmedicine.typepad.com

  18. Frankly, it is more than radiologists that should be concerned. Corporations that are self insured are now sharing the savings with patients who agree to have their expensive surgery in India, and the HMOs and other coopertives will soon be doing the same. In my opinion the only thing that is going to save the medical profession is a universal health care system, but doctors seem not to get it yet.

  19. If I was a radiologist or pathologist, I would be truely concerned about my future. Both of these fields do not require the physician to actually see the patient (unless you perform interventional procedures)and nearly ALL radiographs will be digitized by the end of the decade. It wouldn’t be too hard to to do this pathology slides as well.
    Just read “The World is Flat” to get a picture of just how easy it is to export these services oversees.

  20. Try going to medical school and completing a radiology residency before passing judgement

  21. Mr. Watson-
    Not to take this discussion too far afield, but to which Harvard Health Study Group are you referring, exactly? Could you provide a specific literature citation? I doubt it was this one (from the major study most often cited), whose abstract includes this showstopper (check it out for free at http://www.nejm.org): “most of the events for which claims were made in the sample did not meet our definition of adverse events due to negligence” (Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. NEJM 1991;325:245-251). The important conclusions from this landmark study were (1) that injuries due to negligence rarely result in lawsuits, and (2) the majority of lawsuits _do not_ arise from negligent injury. Seems like lawsuits and negligent injury are almost independent events. Maybe you’re using a different definition of “meritorious?” Is an adverse event not due to negligence grounds for a meritorious lawsuit? Please clarify. Oh, and one other thing: it might be good to check your terminology. That way people would be able to trace your statements back to their sources. Googling “Harvard Health Study Group” all I get is the website for your book, a couple of Alternet pages, and some advice to eat breakfast and drink in moderation. No primary published literature, though.

  22. You are so right in your comments about the radiologists. They generally do not even have to see patients, so they can do their work on the hours they choose. The “liability issues” that they claim scare them are actually scares that have been created by the insurance industry, as there is no data to support the industry claims that lawsuits are going up, or that thet lawsuits that do occur are frivolous. The Harvard Health Study Group found that that great majority of lawsuits are meritorious. Recent studies have shown, also, that there are more physicians per capita in states where the legislatures have not put dollar limits on damages in malpractice suits. So, whatever fear it is that radiologists, or other doctors have, about lawsuits, is a fabricated one that was created just to give impetus to attempts to limit damages in cases against negligent doctors. Michael Townes Watson, author of America’s Tunnel Vision–How Insurance Companies’ Propaganda Is Corrupting Medicine and Law.

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