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Why is rads considered a high paying specialty?


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Current radiology resident with lots of student loan debt and so no significant savings. I'm aiming to eventually settle down in a high COL city which has relatively poor pay.

I've been trying to educate myself about a realistic financial future and have gotten pretty discouraged. Based on forums, sounds like community radiologists pay 60-75% overhead. Academic radiologists seem to pay no overhead but make significantly less. Further, I've heard vague statements about million-dollar buy-ins to even join a group. As such, why does radiology have a rep for being a high-earning specialty? Am I misunderstanding these forums posts? Am I missing some sort of key $$ info that staff rads don't tell us until we're in practice?

(P.S. I love rads and didn't choose it for the money, despite the nature of this post seeming to imply otherwise. I'm also NOT trying to start a topic about income disparities between specialties please. Just really lost and looking for credible information sources about this.)

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On 4/18/2022 at 6:40 AM, RadiologySWITCH said:

Am I misunderstanding these forums posts? Am I missing some sort of key $$ info that staff rads don't tell us until we're in practice?

Hi;

Academic and community radiologists are both paid quite well, and there is a wide range, even within both sectors.  In Ontario, depending on the practice location, academic radiologists make anywhere from $300-$750K, baseline, and can earn more for taking extra call.  Some academic rads also choose to do teleradiology work as well, which helps to bump up their income.  Community radiologists tend to earn more.  It's not unheard of for community rads to earn high six figures, or seven.

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On 4/18/2022 at 6:40 AM, RadiologySWITCH said:

Current radiology resident with lots of student loan debt and so no significant savings. I'm aiming to eventually settle down in a high COL city which has relatively poor pay.

I've been trying to educate myself about a realistic financial future and have gotten pretty discouraged. Based on forums, sounds like community radiologists pay 60-75% overhead. Academic radiologists seem to pay no overhead but make significantly less. Further, I've heard vague statements about million-dollar buy-ins to even join a group. As such, why does radiology have a rep for being a high-earning specialty? Am I misunderstanding these forums posts? Am I missing some sort of key $$ info that staff rads don't tell us until we're in practice?

(P.S. I love rads and didn't choose it for the money, despite the nature of this post seeming to imply otherwise. I'm also NOT trying to start a topic about income disparities between specialties please. Just really lost and looking for credible information sources about this.)

you have to be extremely careful with the overhead and income levels - 

all income for doing radiology in the billing codes is divided into money paid to read the study (professional fees), and money paid to create the study (technical fees). Often the technical fees are higher - you have to pay for staff, equipment, buildings and so on and it is not cheap. 

They problem then becomes what is the radiologists income, and what is overhead. Quite often the full cost of the creating the study is the full technical fees (and sometimes actually even more). That means logically the technically fees are intended to be overhead right from the beginning. If you are counting technical fees and the professional fees together as your income, and the immediately subtracting the same technical fees as overhead it looks like your overhead is through the roof (as you say 70%). That is a bit silly as you were never supposed to be taking home the technical fees as income. 

Worse when you own a clinic often a single rad - the owner - maybe the one billing the government for the technical fees created for a volume of studies that many other radiologists that work there are actually reading. So you have one person "billing" millions - but immediately paying that out to run the business. Again technical fees were never really income - but on paper you can get his sky high levels as a result, and since people don't understand how this work they think someone is making millions. No, they are billing millions for work that costs millions to do. 

In academia the hospital is running the process of creating the imaging studies not the radiologists. The hospital directly gets the technical fees, not the radiologists. Thus the academic radiologists overhead is extremely low. Their income also appears lower but that is a combination of no technical fees, and reduced volume of clinical work compared to a community radiologist so less professional fees as well - teaching people is wonderful but it takes time, and in medicine - particular a field like radiology where you can just keep reading cases - that time is money. Unlike other fields trainees cannot sped up a staff radiologist in anyway. 

For some community practices there is a high buy in - but you again have to put that into perspective - you are not buying some vague entry fee - you are buying an ownership stake in the actual equipment as well. That equipment is not cheap at all (for fun look up how much an X Ray machine really costs, or an US). This fair because the rad that started the clinic had to buy that equipment PRIOR to creating any studies, and you can only bill the government for doing a study, not setting up something to create studies. It is unfair for you to just automatically reap the benefits without payback for the cost but of course as an owner now you will be getting those technical fees (which in part are designed to eventually payback the cost of clinic setup which is again all overhead). 

You have buy ins all over the place in medicine for the same reason - even at academic groups for many specialties (sorry to suprise anyone with that ha - there is always another cost down the line that pops up in medicine). There are usually some assets sitting around that you are now a part owner for when you join a partnership - you need to pay your share of that when you come in. For me that is coming up soon ha - there goes a chunk of cash :)

Strip all this stuff away and for now yes radiology remains on the higher side of income (in part because we have dramatically upped the number of hours we work compared to the past - I am routinely putting in 60-70 hour work weeks here, week after week. my apologies for not posting as much lately ha). 

 

 

Edited by rmorelan
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