Weep for the radiologists

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I am sure this will bring me a whole new batch of hate mail, but I can’t ignore the story. I feel like Nina Bernstein wrote it just for me. “Job Prospects Are Dimming for Radiology Trainees“:

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 anymore. Radiologists still make twice as much as family doctors, but are high on the list of specialists whose incomes are in steepest decline. Recent radiology graduates with huge medical school debts are having trouble finding work, let alone the $400,000-and-up dream jobs that beckoned as they signed on for five to seven years of relatively low-paid labor as trainees.

It’s always amazing to me that the stories like this are always written about or by radiologists, or anesthesiologists, or orthopedic surgeons. They often feel like they are owed more money. It’s like… an entitlement.

You know who else trained for five years? Me. It takes six years to be an neurologist,  an immunologist, a nephrologist, a rheumatologist, or an endocrinologist. Almost none of those specialties expect to have a “$400,000-and-up dream job”.

“We were somewhat victims of our success,” said Dr. Ellenbogen, in Dallas, whose career spans what radiologists call the golden years, when the cost of diagnostic imaging grew faster than other items in health care.

Starting in the 1980s, the advent of technology like M.R.I.’s and CT scans, combined with a fee-for-service system, created ballooning demand for imaging and drove the compensation of radiologists to unsustainable heights, he said. “That led to a sense of entitlement in some people’s minds,” he said. “And that led to this development of offshore remote reading of cases.”

I’m going to give my usual caveat here. I’m not calling for salary caps or anything like that. I know plenty of physicians who work insane hours for arguably low pay. I also know many who come out of training with $200,000 – $300,000 in debt. In order to pay that off, they do often need to make higher than average salaries. They do. It’s also true that physicians are very highly trained. I often joke to my kids that by the time I was done and ready to get a “real” job, I had just finished the 25th grade.

But, contrary to what many believe, this is still a free market. Someone, somewhere, is going to realize that there are physicians who are overpaid. In this case, it’s some (not all!) radiologists. We also know that we need more primary care docs and fewer specialists – and this is how we get there.

Before you get too misty, radiologists are still doing pretty well:

Last year, an annual salary survey of 24,000 physicians by Medscape, an online resource for doctors, found radiologists and orthopedic surgeons still topped the list of specialties, but their mean incomes had dropped by 10 percent between 2010 and 2011, to $315,000 from $350,000.

Perhaps those salaries are deserved. But they can’t be justified on “length of training”, as many, many less-well-paid specialties train as long or longer. They can’t be justified on debt for the same reason. The best argument would be on quality and outcomes, but that never seems to happen.

This doesn’t help, either:

“The times of graduating from medical school and driving a Porsche are done,” said Dr. Dana Lowenthal, a first-year radiology resident and fourth-generation doctor. “It was never easy, but there was light at the end of the tunnel. This is new territory.”

If your definition of “struggling” is not driving a Porsche, then it’s time to stop expecting the general public to give you any sympathy. I’ve said it before, and I’ll say it again. Is there any other profession that is as tone deaf as we are when it comes to talking about our livelihood? Is there any other profession that feels so free to complain about making too little, when they objectively make so much compared to so many others?


P.S. Here’s a piece about St. Barnabas and its ex-CEO Ronald Gade, who was a – wait for it – radiologist that an eagle eyed reader sent me.

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