Radiologists are no longer on the ROAD

[Prince Medward]

A new article in the New York times suggestst that the "you can always go to the states" mantra has run its course for radiologists:

 

"For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work. Not any more."

 

http://www.nytimes.com/2013/03/28/health/trainees-in-radiology-and-other-specialties-see-dream-jobs-disappearing.html?src=rechp&_r=0

[Med0123]

This is NOT AT ALL Canada's situation

 

 

 

 

not yet.

[waterboy2014]

A new article in the New York times suggestst that the "you can always go to the states" mantra has run its course for radiologists:

 

"For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work. Not any more."

 

http://www.nytimes.com/2013/03/28/health/trainees-in-radiology-and-other-specialties-see-dream-jobs-disappearing.html?src=rechp&_r=0

 

 

This article and other trends in the radiology world raise questions:

 

1) Do we have the same drivers here in Canada that will reduce Radiologist income?

> I think so. All western countries are essentially contracting IMO, debt ridden, and economies flatlining. Anybody that is depending on the government for money will see less of it. Including MD's

 

2) Can we stop it? mitigate it?

> Radiology needs to show more value for the work they do. New innovative services such as reading CT's to patients etc would help out. The current method of increasing workload for the same amount of income or less is not sustainable. (Radiologist's are burning out)

http://www.medscape.com/features/slideshow/lifestyle/2013/radiology?src=wnl_edit_specol&uac=197281MZ

 

3) Would I still do Radiology?

Absolutely. This goes to show you again to do what you love.

 

What do you gals and guys think?

[mavrik13]

It makes sense that the income from radiology is coming down - increased investment in technology (e.g. more CT, MRI, and keeping those machines running more often) shouldn't lead to increased billing income from radiologists.

 

Other specialties, e.g. Family Med, will never gain any increase in billing from government investment into technology.

 

This is what they should have done to ophthalmology as technology improved. There is too much disparity between specialty billings.

 

The complaint from radiologists that I would consider valid is the increase in their expected workload - it is no longer a cushy lifestyle. Even still, at least here in Canada, they are extremely well compensated for the amount of work that they do.

[tooty]

they are extremely well compensated for the amount of work that they do.

 

not quite. depends on the city, the group, and actually the radiologist. the high income potential is there, but the same goes for family docs. you could argue that all physicians are extremely well compensated "for the amount of work that they do" seeing as how $200k is the top 1%

 

back to the topic, it looks like things are variable in the states. job prospects can be good depending on location. http://www.auntminnie.com/forum/tm.aspx?m=380075

[rmorelan]

It makes sense that the income from radiology is coming down - increased investment in technology (e.g. more CT, MRI, and keeping those machines running more often) shouldn't lead to increased billing income from radiologists.

 

Other specialties, e.g. Family Med, will never gain any increase in billing from government investment into technology.

 

 

The different is that keeping those machines running as much as they do can cause rads to work their asses off to try and keep up. It isn't like optho were suddenly a 2 hour procedure takes 10 mins and you bill the same. Every time those machines get better at this point there is a bump in the number of images you have to read even for the same case (more slices, more things to look at) and the billing rate is the same.

 

In the long run I think the income will come down for sure! Probably stabilizing around the same rate as a well paid internal medicine doc (?)

[AtomSmasher19]

This is inevitable for a specialty so dependent on technology, which changes and improves rapidly. I think that eventually, the liability issues will get sorted out and radiology is going to be outsourced to China/India. The financial incentive for the government paying a radiologist in India $20K per year compared to a radiologist in Canada $400K per year is a big motivation for them to make something happen in this regard.

 

Oh well. That still leaves O and D.

[rmorelan]

This is inevitable for a specialty so dependent on technology, which changes and improves rapidly. I think that eventually, the liability issues will get sorted out and radiology is going to be outsourced to China/India. The financial incentive for the government paying a radiologist in India $20K per year compared to a radiologist in Canada $400K per year is a big motivation for them to make something happen in this regard.

 

Oh well. That still leaves O and D.

 

ha I guess I would say as well the tech angle can be applied to a lot other fields in medicine as well. Why not outsource path (digital slides), large parts of cardiology (we already do tele cardiology within canada, and moving on other areas as well).

 

Fortunately radiologists do a lot more than just interpret images and outsourcing is not as easy as it often portrayed.

[mavrik13]

not quite. depends on the city, the group, and actually the radiologist. the high income potential is there, but the same goes for family docs. you could argue that all physicians are extremely well compensated "for the amount of work that they do" seeing as how $200k is the top 1%

 

Considering the average income for a radiologist is estimated at 700k in Ontario, without overhead (very few even have an administrative assistant), I would say they are extremely well compensated, even if they have to put in 80 hour weeks. I know many radiologists at my home institution that only work 0.8 FTE... just because they can, while still having a very generous income.

 

The different is that keeping those machines running as much as they do can cause rads to work their asses off to try and keep up. It isn't like optho were suddenly a 2 hour procedure takes 10 mins and you bill the same. Every time those machines get better at this point there is a bump in the number of images you have to read even for the same case (more slices, more things to look at) and the billing rate is the same.

 

In the long run I think the income will come down for sure! Probably stabilizing around the same rate as a well paid internal medicine doc (?)

 

I agree - there is more complexity in interpreting CT/MR as technology increases - my point was that CT/MR billings are worth more per unit time than plain film X-ray/ultrasound, and that with the ever increasing shift to more CT/MR, radiologist income has ballooned largely as a function of the technology shift (in addition to interventional rads... but that is an entirely separate cash cow)

[rmorelan]

wait for the push for low intensity CT lung screening - that just sounds scary from a cost point of view.

[tooty]

Considering the average income for a radiologist is estimated at 700k in Ontario, without overhead (very few even have an administrative assistant), I would say they are extremely well compensated, even if they have to put in 80 hour weeks. I know many radiologists at my home institution that only work 0.8 FTE... just because they can, while still having a very generous income.

 

Lots of internists, family docs, emerg docs working less than 1.0 FTE just because they can. Your 700k quote is from the will falk's article on longwoods. It is from 2009 and does it apply now. I also seriously question the reliability of his research given the nature of the article.

 

What do you know of how much those radiologists worked to earn 700k? They bill for each study they interpret and have a high throughput per hour. By your saying that they are "extremely well compensated for the amount of work they do" are you implying that they're overpaid per hour or that their services are overvalued?

[mavrik13]

Lots of internists, family docs, emerg docs working less than 1.0 FTE just because they can. Your 700k quote is from the will falk's article on longwoods. It is from 2009 and does it apply now. I also seriously question the reliability of his research given the nature of the article.

 

What do you know of how much those radiologists worked to earn 700k? They bill for each study they interpret and have a high throughput per hour. By your saying that they are "extremely well compensated for the amount of work they do" are you implying that they're overpaid per hour or that their services are overvalued?

 

My argument is that the interpretation of scans must be overvalued if radiologists are able to bill, on average, 700k. We could debate the validity of that estimate, but I haven't seen any other estimates so I'm running with it. Either way, Falk has a great point in that we (as a population, not as physicians) invest a lot of our money in decreasing health care costs... a relevant example he brings up is the computerization of plain film radiology, which leads to higher throughput and higher billings for the radiologist, but no savings for the healthcare system because that just means more physicians can order more scans for more patients.

 

I'm a proponent that no physician should be making over 300k (not a firm number, of course...) a year, and that there shouldn't be such a variation between remuneration between specialties. There is no reason that the top billing physician in Ontario should bill for over 6 million dollars a year. Take a wild guess what he is doing.

 

Call it what you like, but there are very few procedures that I can think of that require inherent talent or abilities to perform. We greatly overvalue the procedure aspect of medicine relative to the 'thinking' aspects of medicine, which is clearly present if you take a look at billings by specialty.

 

We should be choosing our specialties by the public's interest, because that is who funds the majority of our education, and that is who we serve as physicians - not by remuneration, which is largely how it is done now (whether by $$$ or by job availability, which still comes down to $$$).

 

Sorry about the rant - certainly not directed at you - but I think anyone would agree that physician remuneration is a broken system.

[A-Stark]

My argument is that the interpretation of scans must be overvalued if radiologists are able to bill, on average, 700k.

 

Yes.

 

Call it what you like, but there are very few procedures that I can think of that require inherent talent or abilities to perform. We greatly overvalue the procedure aspect of medicine relative to the 'thinking' aspects of medicine, which is clearly present if you take a look at billings by specialty.

 

This I don't really agree with. Not everyone can be a cardiac surgeon, though it's equally true that ophthalmologists have not become more talented in proportion to their increase in remuneration.

[Prince Medward]

What are the characteristics of a strong lobby? Why can't government just say take a cut or take a hike?

 

Ophthalmologists make a killing around cataract surgery anyway, billing hundreds of dollars per patient privately for retractions, corneal topographies which they claim the government does not pay for. They are technically right but those things should be thought of as part of the surgical procedure. The money they make is astounding and obscene.

[rmorelan]

What are the characteristics of a strong lobby? Why can't government just say take a cut or take a hike?

 

Ophthalmologists make a killing around cataract surgery anyway, billing hundreds of dollars per patient privately for retractions, corneal topographies which they claim the government does not pay for. They are technically right but those things should be thought of as part of the surgical procedure. The money they make is astounding and obscene.

 

Helps if you have a fall back position to start with - Rads historically are pretty mobile since they have no patient roster. You start pushing them too hard and well they leave - they can take a hike.

[Prince Medward]

Helps if you have a fall back position to start with - Rads historically are pretty mobile since they have no patient roster. You start pushing them too hard and well they leave - they can take a hike.

 

I question how valid the threat of leaving is. People have children, friends, relatives, spouses with their own careers which may tie them down locally and many factors other than salary compell them to stay put.

 

I for one would move out of vancouver to a cheaper to live in, higher paying province if not for my wife and her career.

[rmorelan]

I question how valid the threat of leaving is. People have children, friends, relatives, spouses with their own careers which may tie them down locally and many factors other than salary compell them to stay put.

 

I for one would move out of vancouver to a cheaper to live in, higher paying province if not for my wife and her career.

 

Professionals move all the time for jobs in many fields - the pattern is out there enough that it has been relied on (generally the more you make the more likely you are going to have to move in most careers). Plus a lot of rads at least in the past has less of a problem with spousal careers.