Climate in Diagnostic Radiology

[tb_or_not_tb]

I was looking through the older threads on diagnostic radiology income, but it seems like a lot of the information might be too old since the recent cuts by Ontario government. Also, cma profile data is interesting, but it often needs more validation and some particular aspects are not necessarily covered by the report. Therefore, few questions for people who are familiar with the field:

-What kind of income is it realistic to expect fresh out of residency? In general, is it more or less than most of the specialized surgical specialties?

-Currently, what is the upper limit of income achievable in diagnostic radiology (non-interventional)? Leading to next question:

- Ontario government constantly mentions radiologists billing over 1 mill; how much of that is lost to overhead (if any; a lot of conflicting information about overhead in general)?

-What are the trends, in your opinion, in terms of future income? More cuts coming, or other fields like interventional cards or ophtho will be targeted instead?

-What is the situation with diagnostic radiology billing in other provinces outside Ontario?

-How easy is it to find job in big city (Toronto, Vancouver, Mtl) fresh out of residency/fellowship?

-Are 12 week annual vacation contracts still common?

 

Also, any opinions on why radiology residency became so non-competitive in the past years?

 

Thanks

[bloh]

You need to do some reflecting. Every single specialty in medicine gives you an excellent income. Focus on other aspects of the field or you'll be a miserable wreck and no richer than any of your peers.

[Edict]

Income for specialists is often determined by fortunate or unfortunate accidents rather than planning. You'll probably find the ophthalmologists who benefited most from the technological improvements in cataract surgery didn't even enter the field at a time when cataract surgery billed well. Same with people who chose fields that paid well and now no longer do. There is so much variation with practice, location, that you can't really tell. Generally speaking you can expect a general income range when choosing a specialty but income should not be high on the list when choosing a specialty or else you will likely be disappointed. 

[indefatigable]

6 hours ago, Edict said:

Income for specialists is often determined by fortunate or unfortunate accidents rather than planning. You'll probably find the ophthalmologists who benefited most from the technological improvements in cataract surgery didn't even enter the field at a time when cataract surgery billed well. Same with people who chose fields that paid well and now no longer do. There is so much variation with practice, location, that you can't really tell. Generally speaking you can expect a general income range when choosing a specialty but income should not be high on the list when choosing a specialty or else you will likely be disappointed. 

This is a great point.  Not only is there a lot of unpredictability of the future, the highest paid specialties often also have the highest variation in income (with biggest difference between mean and median earnings) with high overhead.  It's too easy to assume one would be a high earner within the specialty before even starting.  So chasing income can easily lead to career dissatisfaction when the specialty doesn't have other advantages in terms of lifestyle, location, etc...    

[tb_or_not_tb]

Thanks for input and great point about unpredictability of future trends.

Unfortunately, a some people in this discussion jump to conclusion that income is the only factor in OP's calculus. What is omitted in their reasoning is that compensation is just one of the important factors that differentiaties between a good match and the best match.

I do not advocate anyone to go into specialty that has 0 intellectual appeal to them, but is highly lucrative - seeing that such path leads to misery is a pearl of wisdom by captain obvious. However, I do advocate for a compatible specialty with a good income over another equally compatible specialty with lower income. 

Anyway, a lot of anxiety and stress in medical field comes from the needless repression of materialistic self, often mediated by social pressure. Neglecting money/prestige and focusing on naive maximalist idealism is a common trait of an undifferentiated premed, whereas mature physcians embrace the pluralism of motivations and accept colleagues with diverse drives, whether it's lifestyle, intellectual appeal, money, altruism or raw status-seeking.

 

[Hellothere77]

11 minutes ago, tb_or_not_tb said:

Thanks for input and great point about unpredictability of future trends.

Unfortunately, a some people in this discussion jump to conclusion that income is the only factor in OP's calculus. What is omitted in their reasoning is that compensation is just one of the important factors that differentiaties between a good match and the best match.

I do not advocate anyone to go into specialty that has 0 intellectual appeal to them, but is highly lucrative - seeing that such path leads to misery is a pearl of wisdom by captain obvious. However, I do advocate for a compatible specialty with a good income over another equally compatible specialty with lower income. 

Anyway, a lot of anxiety and stress in medical field comes from the needless repression of materialistic self, often mediated by social pressure. Neglecting money/prestige and focusing on naive maximalist idealism is a common trait of an undifferentiated premed, whereas mature physcians embrace the pluralism of motivations and accept colleagues with diverse drives, whether it's lifestyle, intellectual appeal, money, altruism or raw status-seeking.

 

I'd never seen anyone advocate so passionately for the virtue of money and prestige. Well done, it would be such a tragedy if they took a back burner in anyone's life

[GrouchoMarx]

still better than in pathology

 

the oma recently decided to label pathologists as overpaid based on their stupid CANDI model, even though the whole pathologists being salaried drones thing makes it totally inaccurate.

 

pathology is expecting to be cut further.

 

nothing will be done because pathologists have no spines. they are worms.

 

radiologists are the fish. fish eat worms.

[LostLamb]

59 minutes ago, tb_or_not_tb said:

Thanks for input and great point about unpredictability of future trends.

Unfortunately, a some people in this discussion jump to conclusion that income is the only factor in OP's calculus. What is omitted in their reasoning is that compensation is just one of the important factors that differentiaties between a good match and the best match.

I do not advocate anyone to go into specialty that has 0 intellectual appeal to them, but is highly lucrative - seeing that such path leads to misery is a pearl of wisdom by captain obvious. However, I do advocate for a compatible specialty with a good income over another equally compatible specialty with lower income. 

Anyway, a lot of anxiety and stress in medical field comes from the needless repression of materialistic self, often mediated by social pressure. Neglecting money/prestige and focusing on naive maximalist idealism is a common trait of an undifferentiated premed, whereas mature physcians embrace the pluralism of motivations and accept colleagues with diverse drives, whether it's lifestyle, intellectual appeal, money, altruism or raw status-seeking.

 

Am I the only one who finds it bizarre that the OP refers to themselves in third person in this post, and defends him/herself thusly?

 

anyways, to reply to the OP, you’ll find outliers in terms of salary in any field that is fee for service.  If there’s money to be made and you have the drive, ambition, gumption, and energy you can bring in $1M minus non-surgical overhead. 

Just don’t expect to be taking a quarter of the year off doing it, unless you’re extremely crafty with billing, prepared for being audited, and can work 18h+ a day. 

Sorry for the (slight) sarcasm but you’ve gotten some excellent advice from the above posters and unfortunately non of us has a crystal ball. 

Best of luck in your career search!

LL

[pretomd]

7 hours ago, LostLamb said:

Am I the only one who finds it bizarre that the OP refers to themselves in third person in this post, and defends him/herself thusly?

 

anyways, to reply to the OP, you’ll find outliers in terms of salary in any field that is fee for service.  If there’s money to be made and you have the drive, ambition, gumption, and energy you can bring in $1M minus non-surgical overhead. 

Just don’t expect to be taking a quarter of the year off doing it, unless you’re extremely crafty with billing, prepared for being audited, and can work 18h+ a day. 

Sorry for the (slight) sarcasm but you’ve gotten some excellent advice from the above posters and unfortunately non of us has a crystal ball. 

Best of luck in your career search!

LL

I find it a bit odd too. But I like OP's pomposity and speechifying. It makes their defence riveting and moving to the point where I forget it's a defence of money.

Not that there's anything wrong with that! Money's a fair motivator and it exists in medicine with that specific purpose: to attract people. But yeah, it does seem a bit problematic to only be concerned with the money aspect and overlook the others.

To OP: you say it's not just money and there are other factors (possibly "intellectual appeal"). Fine. Good. The reason you got a lot of "Look beyond money" advice is because that's all you asked about in your original post for radiology (or plastic surgery, for that matter) and didn't ask about the other considerations. And radiology and plastic surgery are, well, a bit notorious for being high-paying jobs. If there are other factors drawing you to radiology or plastic surgery, then good on you. But insofar as money and pay is concerned, I think you've got some really good advice sprinkled in with the slight ridicule in this thread. Cheers. 

[rmorelan]

On 7/24/2018 at 1:25 PM, tb_or_not_tb said:

I was looking through the older threads on diagnostic radiology income, but it seems like a lot of the information might be too old since the recent cuts by Ontario government. Also, cma profile data is interesting, but it often needs more validation and some particular aspects are not necessarily covered by the report. Therefore, few questions for people who are familiar with the field:

-What kind of income is it realistic to expect fresh out of residency? In general, is it more or less than most of the specialized surgical specialties?

-Currently, what is the upper limit of income achievable in diagnostic radiology (non-interventional)? Leading to next question:

- Ontario government constantly mentions radiologists billing over 1 mill; how much of that is lost to overhead (if any; a lot of conflicting information about overhead in general)?

-What are the trends, in your opinion, in terms of future income? More cuts coming, or other fields like interventional cards or ophtho will be targeted instead?

-What is the situation with diagnostic radiology billing in other provinces outside Ontario?

-How easy is it to find job in big city (Toronto, Vancouver, Mtl) fresh out of residency/fellowship?

-Are 12 week annual vacation contracts still common?

 

Also, any opinions on why radiology residency became so non-competitive in the past years?

 

Thanks

Hi there! I will try to answer some of this 

out of residency itself is a bit of a trick question as most of us (by most I mean 90%) do fellowships which most places look for in candidates now. You can locum fresh out, and some do find jobs but fellowship is by far the norm.

for the over a million - usually is a lot as that is a trick by the government. When you bill you have both technical and professional fees. The technical fees cover the costs of your equipment and staff. If you run certain clinic types your technical fees are huge - but it goes to cover the your US techs, your building, equipment..... I know some people in the "millions" range but most of it goes towards that. The technical fees often don't cover the true cost of the exam either so you subsidize it from the professions ones. US techs earn 80-100K a year and for every rad in a clinic often you need 4-5 of them. You can see where money is going ha.

More cuts are coming. Coming to all the high paid ones.

similar but better in a few other provinces for now. 

getting a big city job can be a challenge - you need the fellowship and patience there. 

there is trade off between income and vacation - 10 weeks plus or minus isn't unusual but I will point the more vacation you have the busier the non vacation time tends to be. The first several years out of residency/fellowship can be extremely brutal. Early days, late days, weekends and call...... it is a ton of hours. People look forward and see rads paid the same as everyone else but working hours that are comparatively "inconvenient"

Non competitive? well less competitive I would say ha - kind of simple I think if not wonderful - people realize now radiology has long hours, a lot of call and weekend work, with continuing cuts, and even the work during the day is extremely busy. As an example as a fellow now trying to basically work like staff I have a standard 9 hour shift where I might get 10 minutes to eat lunch at my desk. They rest is pure maxed out reading.  

 

 

[Edict]

On 7/25/2018 at 11:29 PM, tb_or_not_tb said:

Thanks for input and great point about unpredictability of future trends.

Unfortunately, a some people in this discussion jump to conclusion that income is the only factor in OP's calculus. What is omitted in their reasoning is that compensation is just one of the important factors that differentiaties between a good match and the best match.

I do not advocate anyone to go into specialty that has 0 intellectual appeal to them, but is highly lucrative - seeing that such path leads to misery is a pearl of wisdom by captain obvious. However, I do advocate for a compatible specialty with a good income over another equally compatible specialty with lower income. 

Anyway, a lot of anxiety and stress in medical field comes from the needless repression of materialistic self, often mediated by social pressure. Neglecting money/prestige and focusing on naive maximalist idealism is a common trait of an undifferentiated premed, whereas mature physcians embrace the pluralism of motivations and accept colleagues with diverse drives, whether it's lifestyle, intellectual appeal, money, altruism or raw status-seeking.

 

This would be a reasonable point if you weren't the one asking the question in the first place. Please, tell us more about the beliefs of "mature physicians" like yourself. 

[1D7]

On 7/25/2018 at 11:29 PM, tb_or_not_tb said:

Thanks for input and great point about unpredictability of future trends.

Unfortunately, a some people in this discussion jump to conclusion that income is the only factor in OP's calculus. What is omitted in their reasoning is that compensation is just one of the important factors that differentiaties between a good match and the best match.

I do not advocate anyone to go into specialty that has 0 intellectual appeal to them, but is highly lucrative - seeing that such path leads to misery is a pearl of wisdom by captain obvious. However, I do advocate for a compatible specialty with a good income over another equally compatible specialty with lower income. 

Anyway, a lot of anxiety and stress in medical field comes from the needless repression of materialistic self, often mediated by social pressure. Neglecting money/prestige and focusing on naive maximalist idealism is a common trait of an undifferentiated premed, whereas mature physcians embrace the pluralism of motivations and accept colleagues with diverse drives, whether it's lifestyle, intellectual appeal, money, altruism or raw status-seeking.

 

Forgot to change accounts?

[NeuroD]

This and the plastic surgery post had a 99% chance of getting toxic. These conversations are always difficult in medicine.

[rmorelan]

On 7/28/2018 at 2:27 PM, PhD2MD said:

This and the plastic surgery post had a 99% chance of getting toxic. These conversations are always difficult in medicine.

Ha there are - it clashes different groups' approach to things. 

I would argue that a lot of the stress and anxiety in medicine is also the over expression of the material self - also mediated by social pressure and a ton of targeted marketing. Doctors "have" to live in big houses, drive expensive cars, wear fine clothes..... suddenly they are dependent on that income and just like everyone else - slave to a mortgage, long work hours, and a lifestyle they barely have time to enjoy (or simple don't have time at all). Living paycheck to paycheck and not really getting ahead. You hear people complaining as doctors about that all the time in the field. 

Balance is possible between the extremes. Like most things I think that is a happier place. Doing something because you want to do is going to lead to a happier place than having to do it. 

[NeuroD]

2 hours ago, rmorelan said:

Ha there are - it clashes different groups' approach to things. 

I would argue that a lot of the stress and anxiety in medicine is also the over expression of the material self - also mediated by social pressure and a ton of targeted marketing. Doctors "have" to live in big houses, drive expensive cars, were fine clothes..... suddenly they are dependent on that income and just like everyone else - slave to a mortgage, long work hours, and a lifestyle they barely have time to enjoy (or simple don't have time at all). Living paycheck to paycheck and not really getting ahead. You hear people complaining as doctors about that all the time in the field. 

Balance is possible between the extremes. Like most things I think that is a happier place. Doing something because you want to do is going to lead to a happier place than having to do it. 

The challenge when it comes to practical issues like specialty selection is that it's unlikely you'll actually now what you will truly enjoy when your picking based on the info your given in clerkship. So the etermal question (debate?) is: should people try to looking into a crystal ball, or be more cynical and let there choice be more heavily guided by financial rewards.

[rmorelan]

1 hour ago, PhD2MD said:

The challenge when it comes to practical issues like specialty selection is that it's unlikely you'll actually now what you will truly enjoy when your picking based on the info your given in clerkship. So the etermal question (debate?) is: should people try to looking into a crystal ball, or be more cynical and let there choice be more heavily guided by financial rewards.

ha, problem is the fields for the most part with the most money have the worst lifestyle, which in the end is the usual cause of physician discomfort. 

Radiology - high pay but you will work your ass off and work weird hours for it (seriously)

Cardiology - high pay but you will your ass off and/or work weird hours for it (the higher the pay - interventional for instance - the high the work load and risk you won't even get it at all)

Plastics - only in private practice and only if you good at the marketing side. Still a lot of work

Dermatology - better than internal but not by much. However absolutely a good lifestyle. No wonder it is popular, which means it is hard to get

Ophthalmology - better than some but the overheads, dropping fees and dried up lasix market take their toll. 

and so on. Even time on the forum someone says you can "easily" make X in another field (usually family medicine) they are probably right - but the common denominator will be there, you have to work your ass off.  All in the back drop of everyone trying to get rid of any differences - and they probably will. 

 

[NLengr]

1 hour ago, rmorelan said:

ha, problem is the fields for the most part with the most money have the worst lifestyle, which in the end is the usual cause of physician discomfort. 

Radiology - high pay but you will work your ass off and work weird hours for it (seriously)

Cardiology - high pay but you will your ass off and/or work weird hours for it (the higher the pay - interventional for instance - the high the work load and risk you won't even get it at all)

Plastics - only in private practice and only if you good at the marketing side. Still a lot of work

Dermatology - better than internal but not by much. However absolutely a good lifestyle. No wonder it is popular, which means it is hard to get

Ophthalmology - better than some but the overheads, dropping fees and dried up lasix market take their toll. 

and so on. Even time on the forum someone says you can "easily" make X in another field (usually family medicine) they are probably right - but the common denominator will be there, you have to work your ass off.  All in the back drop of everyone trying to get rid of any differences - and they probably will. 

 

To me anyway, dermatology seems like the most mind numbingly boring specialty on the face of the earth. 

My specialty is well compensated but I have come to realize I value time off more than extra cash. I could make more money if I spent more time working but I'd rather play hockey, hang with my family/friends and drink beer instead of banking an extra 10k a month. I think it's pretty common for a lot of staff. 

[NeuroD]

Just now, NLengr said:

To me anyway, dermatology seems like the most mind numbingly boring specialty on the face of the earth. 

I bet its fascinating and stimulating, but they keep it to themselves to prevent competition.

[Blasé]

23 hours ago, 1D7 said:

Forgot to change accounts?

Everyone following in KD's footsteps with them burner accounts LOL

[Edict]

9 hours ago, PhD2MD said:

The challenge when it comes to practical issues like specialty selection is that it's unlikely you'll actually now what you will truly enjoy when your picking based on the info your given in clerkship. So the etermal question (debate?) is: should people try to looking into a crystal ball, or be more cynical and let there choice be more heavily guided by financial rewards.

But i guess my argument is even the financial rewards may not pan out like you want them to. Generally speaking, once a specialty gets a good gig, people all rush towards that specialty or that practice setting and it becomes ultracompetitive and/or there are no jobs very quickly. 10 years down the line things laws change, tech changes and suddenly what was once well paying can become less well paying. At that point you could be left holding the bag. There certainly are people i'm sure who chased the income, by the time they are looking for the job after residency, the market is saturated, they can't find a good job and settle for some other practice setting, then the laws or tech readjust, that income potential disappears and they watch as friends in the specialty they considered but left behind make a killing because of some new law or tech that benefits them. An example is that family medicine used to not be a well paying specialty but that changed with the introduction of FHTs. There are certainly family doctors who got into the FHTs and are now making gold plating incomes for a lot less work. Another example of people chasing the "good gigs" is in IM subspecialties, cardiology and GI used to be very well paying procedural specialties, everyone went for them, they were ultracompetitive, then they got saturated. People then went for Nephro because running a dialysis unit was a good gig, that got saturated, people went for ICU, that got saturated, then people went for Rheum, Endo and Heme because there were jobs and now people are going for GIM because there are jobs. 

For this reason i argue for doing something you are interested in (most people with enough shadowing and exposure can narrow things down to 2-3 specialties). The interest won't fade, the money might. 

 

[NeuroD]

13 hours ago, Edict said:

 

For this reason i argue for doing something you are interested in (most people with enough shadowing and exposure can narrow things down to 2-3 specialties). The interest won't fade, the money might. 

 

I totally get what your saying, and I'm not advocating picking based purely on income (in fact I'm knowingly going for historically lower paid specialty because of interest...but I always wonder about this point in particular. Your clerkship interest isn't a good gauge, and even if it is, who stays interested in the same field for 50 years? I ask myself this question often.

[Lactic Folly]

Given the scope of medical knowledge in each specialty, and the many pathways for growth, variety, and challenge in a medical career, that's essentially the same question as asking whether you would still be interested in medicine in 50 years. 

[rmorelan]

28 minutes ago, Lactic Folly said:

Given the scope of medical knowledge in each specialty, and the many pathways for growth, variety, and challenge in a medical career, that's essentially the same question as asking whether you would still be interested in medicine in 50 years. 

Yeah and for radiology in particular - this is a technologically driven field and therefore is has perhaps more change than other fields and at a faster rate. We have duel energy CT, multi phase CT, synthetic MRI, functional MRI, 3D and contrast enhanced ultrasound, AI, VR, 3D printing all coming down the pipe line as examples just off the top of my head. Not to mention the expansion interventional work...... 

 

[rmorelan]

On 7/29/2018 at 1:31 PM, Blasé said:

Everyone following in KD's footsteps with them burner accounts LOL

I spend half my life it seems deleting those ha

really what is the point....

[Edict]

9 hours ago, PhD2MD said:

I totally get what your saying, and I'm not advocating picking based purely on income (in fact I'm knowingly going for historically lower paid specialty because of interest...but I always wonder about this point in particular. Your clerkship interest isn't a good gauge, and even if it is, who stays interested in the same field for 50 years? I ask myself this question often.

I think the interest in everything fades over time as it becomes less novel, but I think comparatively, your interest in a specialty you like in clerkship is likely higher than your interest in a specialty you didn't like as much at the same time point.