[Unknown Member]

I do not understand this. Are you saying that UTSW radiologists are overpaid? If so, this is a ridiculous assertion. The chair you noted there has basically snuffed out all faculty raises according to the stories people post here.

[Unknown Member]

Why is it ridiculous?
If they are compensated more than 32 dollars an rvu as I suspect they are then yes. As far as the chair most certainly yes. How is the chair’s income determined? Cronyism? What does the Chair produce?

[Unknown Member]

An academic institution doesn’t need a chairman or section chiefs to generate income by reading ICU CXRs the way a community hack like me does.
 
As what they do has nothing to do with generating RVU, I wouldn’t expect their compensation to be tied to some clinical productivity metric. Any radiologist is welcome to seek that career path and try to get that job if you think it is an easy gig to do or to get. Most rads do not fit the bill and are better off slinging barium and reading cases. But if you are able to serve their role, you can send in your CV and try to underbid him. 

[Unknown Member]

You think his job is up for bid? Question your assumptions? Who pays his salary and why? Is he worth it?
Dr. Rofsky joined UT Southwestern from Harvard Medical School, where he served as Professor of Radiology and Director of MRI at Beth Israel Deaconess Medical Center. While there, he pioneered the development and application of many advanced imaging techniques, including noninvasive magnetic resonance angiography and noninvasive 3-D approaches to measure liver fat and iron within the span of a breath hold. 
 
Research is hard to monetize but 580k per year seems excessive. Why doesn’t he work for GE if his ideas are so valuable? Administrative skill? Really? He found a loophole in capitalism like so many one percenters have…
 
[link=http://www.utsouthwestern.edu/edumedia/edufiles/legal/afr-fy14.pdf]http://www.utsouthwestern…les/legal/afr-fy14.pdf[/link]
2104 224 million operating loss-
The nameless Texas taxpayer is coughing up the difference. 
 
Banner Health has taken over at U of Arizona and putting downward pressure on incomes, shifting to rvu based compensation- expect to see more of this. 

[Unknown Member]

When Academics feel the effects of oversupply through decreased RVU reimbursement every year they will be vigilant about oversupply- 
 
Everyone with a say in the field has to have “skin in the game” to quote Nassim Taleb. 

[Unknown Member]

Banner is used to private rads covering their Phoenix hospitals (including the Phoenix University Hospital where I believe they are hospital-employed). PP groups are the dominant player for the rest of the Banner hospitals. Regardless, RVU-based compensation for academic radiologists would probably drive their salaries up in the majority of markets.
 
The other residencies in Arizona are managed by well-compensated private or hospital-employed radiologists who do capitalize a great deal on government-funded trainee labor.
 
If you are looking for better compensation among academic radiologists, you have to look away from Texas. For instance, look at the IU Health salaries previously quoted. Academic radiologists in Kentucky and West Virginia start out at almost a third more in compensation than Texas.
 
HCA (for profit) bought the Oklahoma medical school’s hospital something like 15 years ago, the academic radiologists were paid about half of the private practice market rate during the ownership, and then the hospital was sold to another company last year. I think it’s safe to say that those rads took a pretty significant compensation hit to do academics.
 
Back to Dallas–those radiologists are paid under market. I would say that the county hospital winds up getting their services at roughly half what they would be charged by a private group (e.g. Maricopa, if you want to compare county hospital to county hospital).
 
As I said, the chair noted appears to be actively suppressing the radiologists’ salaries, so the Texas taxpayers are actually getting a bargain. So I guess that’s his “value.” The rads up there on the salary tally are pre-Rofsky hires. Pride is a neuro-interventionalist. Do you think you can find a neuro-interventionalist that cheaply anywhere else? The academic radiologists there (looking at the entire faculty) appear to be willing to work for the state at $300K with almost no bonus when they could simply jump ship and submit themselves to the RANT/TRA grind which owns most of the remainder of the entire metro.

[enrirad2000]

$300k after taxes isn’t much in Dallas anymore. Real estate is skyrocketing. 

[Unknown Member]

Agree.
 
This appears to be a thread about how academic radiologists are gaming the system. Taking $300K to do radiology is a sacrifice. Many of these academic places have a high volume of low-paying or non-paying patients. This is basically charity care.
 
The best gamers are the ones hosting community radiology programs paid by Uncle Sam while sending a bill to the patients.
 
It’s funny that 1 academic radiologist in charge of 100 underpaid radiologists finally earning what amounts to a PP salary at the end of his career is considered to be an oppressive 1 percenter.

[mariacardei7_785]

I am not sure what the point is. You are worth what they pay you. Sports and acting as examples. If you bring in grants or aid in helping the real generators of clinical dollars, the surgeons doing high end work, you are worth it, if not you get canned

[ljohnson_509]

300k to do radiology a sacrifice?

Isn’t that what many make doing night telerad, working for the corporations and academic departments?

[Unknown Member]

If PP pays $650K or $700K in your market like Oklahoma City, and you take less than half that to work for OU, yeah, that’s a sacrifice.
 
You can make a lot more than that with vRad, Aris, etc. if you put the elbow grease in.
 
If you are in New England making $300 a day, that’s a different story, but they have been over-training radiology residents there for years.

[yamin]

It’s absurd to think that a department chair would make his salary through clinical productivity. The chair position is an administrative position, and that is what the chair is paid for, to lead the department. Similar to the hospital CMO or any other administrative position. 
 
In terms of the other salaries quoted, I’m assuming those are clinical radiologists. Keep in mind that in academics many attendings are bringing in money to the hospital through grants, industry, etc… Also, you’d need to compare those salaries to what the typical PP radiologist is making in the same region. I’m sure PP would still be higher. 

[Unknown Member]

Quote from radsequence

Also, you’d need to compare those salaries to what the typical PP radiologist is making in the same region. I’m sure PP would still be higher. 

PP is higher there. Even the big churner groups in Dallas at least offer partnership-track positions to those who want them. Working for the university simply for a higher salary in Texas would not be a well-informed decision.
 
I did some digging, and this is an instance where all of the academic rads’ money comes from the school/state. Very little bonus. Hospitals pay the school/state; state pays the doctors. Even in Texas, only UT-Houston has a similar compensation arrangement. Many other places have separate checks from the hospital and from the school.
 
Also, several of those listed are not big grant earners, but one is the radiologist-in-chief at the Children’s hospital, 2 others are long-time neuro faculty, another is the new neuro section chief. Leyendecker is Rofsky’s enforcer/second in command pulled out of Wake. These are not routine faculty.
 
Since 2 are ped’s, I looked at the pediatric radiologists, and the full time ones are mostly at $300K regardless of 1 year experience or 10. Sounds awesome to work someplace for 10 years with no raise. This is significantly less pay than the other children’s hospitals in the south. Where do I sign up?

[Unknown Member]

The above provides rational explanation for my gut feeling of being defensive when academic radiologists are criticized for making more money than they ” deserve ” or demonized for whatever woes are afflicting the state of private practice radiology.

What they do is a real labor of love and key to the health of our specialty – training the next generation of radiologists and doing research to advance the field – and if they cannot be paid something commensurate to what PP rads make, the least we can do is show some respect and gratitude.

[Unknown Member]

The reading comprehension skills of “so called radiologists” never ceases to amaze me. Academic radiologists should be compensated but in a manner that reflects the market they influence through the training of additional radiologists. This will provide the necessary feedback to restore the balance between supply and demand in the field.

[Unknown Member]

So cut off the income of people who accept less money to essentially perform a community service while covering Medicaid patients and let everyone be trained by programs managed by the private groups. Awesome idea.

[Unknown Member]

Quote from Feigner

So cut off the income of people who accept less money to essentially perform a community service while covering Medicaid patients and let everyone be trained by programs managed by the private groups. Awesome idea.

 
Feigner may be on to something.

[Unknown Member]

In my humble opinion…
 
Academic radiologists should be compensated sufficiently well to attract the quality of people we wish to do the job.
 
Their concerns should be focused on research, advancements in the field, and training of radiologists. Their careers and their families should not be held hostage to how many job listings there are on the ACR website. Fluctuations in the job market should not cause groups of academic rads to jump ship to private practice when the discrepancy between their income and community radiologists is too great. On some level, for the health of academic radiology – which on average is already making significantly less than PP – their livelihood *should* be insulated from the economics. 

[Patrick]

I take a different tack. As Flounce mentions there is an inherent tension between the private and academic pay rates in a given market. There really is no insulation in that the 2 practice settings are always competing with one another for talent. Low pay in PP will result in low starting salaries for academics. High pay in PP will drive up academic pay rates. In addition, having been in academics, I can say that RVU and other productivity demands are very much part and parcel of academics with some exceptions made for the few (and fewer with direction of grant funding) supported by grants that they work hard to get and maintain.

Last as we race and rant on this board, incumbents (generally more senior) are always somewhat insulated in both PP and academics compared to newbys. It is the nature of the game. Don’t believe me, please, try to create a NON-telerads practice de novo.

I am still sympathetic to some residency spot cuts though, but not easily done as many of have noted on prior posts!

[Unknown Member]

I’ve never seen academic salaries go down. They are usually priced so far under market that even subtle salary hikes over a period of years can’t keep pace. Instead, the market responds by either having IMG’s take the academic jobs (strong market) or the new traditional graduates take them (bad market).
 
IMO, there needn’t be much tension between academic and PP. There are trade-offs. If you just want money, obviously PP is the way to go. If you are willing to take the $300K salary above (plus no state income tax in Texas), you also don’t have to cover SS match, tail malpractice is no big deal, you don’t have to save up for a buy-in, there is more time for CME travel), you often get an academic day (i.e. it’s really an 80% FTE), the hours are more lax, you get your reports dictated for you, you are re-introduced to the state of the art at a decent rate, you may have less kindergarten behavior because your colleagues are not in it for the money and vacation, there is often less call, you get to practice in one subspecialty, etc.
 
A lot of people here also ignore the fact that some doctors actually enjoy teaching residents, writing papers, and/or giving lectures.

[Patrick]

Feigner,
I agree with you in that 1) Academics’ salaries generally are significanlty lower particularly at entry level so they tend not to go down, though I have seen them go down (case in point, Columbia Radiology overnight reimbursement 2009-2014) 2) AMCs can rely on a pool of FMGs and recent grads (Some of whom may not be ready to leave the teat of Mama Academia.  I am hearing many PPs gripe about difficulty on boarding new hires to current volumes), 3) Some people like research and teaching (Though, you DON’T get paid for this and you often don’t get promoted for this).  These factors do mitigate upward and downward pressures, but don’t create a truly insulated market.  In addition, as I have stated AMCs have been benchmarking their rads and increasing productivity standards significantly justs like PP and corporate rads.  I have personally seen volumes double at institutions without corresponding pay increases for faculty such that the net effect like in private practice is a pay cut.  
 
I disagree in that often with an academic job with academic days, you are still required to work 180+ clinical shifts, assuming no grant support for more academic time, which is significantly more than in most PP and certainly more than a 1.0 at mine.  Furthermore, the academic time, if you want to be promoted, is work and not a spa day.  For the standard academics, the lower pay often does correspond to reduced productivity, but this is not always the case, especially in the ER world I come from, where shift volumes near and in some cases exceed PP volumes.  I would not be surprised if the Emory ER rads read more than I do and I am almost sure that my total compensation, salary, benefits, bonus are significantly higher.  I probably also get more vacation, lol.   
 
Though I have seen many lazy, entitled academics in my day, it is not the safe harbor many feel it is, particularly for the young, who are being hired and in many cases churned.  I am watching as many young academics at institutions I was formerly affiliated with seek to jump ship.  

[cieminsjohn]

Just saw this thread and figured I chime in some, months later. 
 
Rad dept makes money off of the technical side as well. Just not professional billing.  Plus there are grants, etc.  Not sure how that figures into everything. 

[Unknown Member]

Do you people have any concept of what it is like to work in academia???
 
First – your billings typically experience a “dean’s tax” after they are received by the practice plan billing company – large percentage right off the top. So that the Dean can have a fund of money to dole out. That increases his power. Then – your salary is at the whim of the chairman – better be a good boy/girl and stay controllable. 
Then you have three jobs – clinical, research, and teaching. And they are mutually exclusive. 
Then you have to spend a good deal of your time working the politics of the job – schmoozing the chairman, putting out fires when your colleagues are jealous of your academic time, your good relationship with the dean or the chairman, your salary, the number of fellows you have, ad infinatum. For me, in the end, that added up to abut 25-30% of my time. 
 
I never worked harder than I did in academics. You need to add in the 2-4 hours of “homework” you have to do – such as presentations, paper writing, grant writing. 
 
If you think that academics is such a wonderful gig, you simply have to get a job in one. They always seem to have openings. Don’t post here – jump right on the gravy train. 

[btomba_77]

Thanks, Sard.
 
But you know that in reality we’re all really just ghost-signing reports generated by unsupervised slave residents and underpaid alternative pathway fellows while we luxuriate on our yachts.
 
My secret plan is to destroy our profession from within.  I personally control all of the residency programs in the nation and am responsible, along with my other sinister colleagues, for all of the over-training of residents.
 
I intentionally fail to educate them so that my enemies in private practice are saddled with underperforming schlubs.  Instead I have them toil in the barium fields from dawn to dusk, learning nothing but padding my gigantic high six-figures academic salary.
 
I never teach or prepare conferences. I never attend multi-disciplinary tumor boards. I never review multiple imaging studies free of charge for sarcoma patients transferred in from the outside.  I never do any of that stuff.   It’s all boat all the time.
 
I do all of this from the inside, hastening the demise of our field. I am the Manchurian Academic Radiologist.
 
 
 

[Unknown Member]

OMG 
I can’t believe you let the secret out. The others on the board were investigating it, and had some damning information. But you just state it straight out. 
Ballsy.
 
(sarcasm off)
 
 
 

[btomba_77]

Quote from Dr.Sardonicus

OMG 
I can’t believe you let the secret out. The others on the board were investigating it, and had some damning information. But you just state it straight out. 
Ballsy.

(sarcasm off)
 
 

 
Fake News! Never mind what I actually said to Lester Holt …. err … Gary Becker ….
 
It’s all the liberal private practice trying to take down [i]real[/i] American academic rads.   

[Unknown Member]

And BTW, the OP cherry picked the data (something we learned in academia was a deceptive practice). 
Here is the data for the 68 assistant professors -not just the top 10 earners in the department:
 

[btomba_77]

Quote from Dr.Sardonicus

And BTW, the OP cherry picked the data (something we learned in academia was a deceptive practice). 
Here is the data for the 68 assistant professors -not just the top 10 earners in the department:

 
Of course he did. 

[Unknown Member]

The medicare data was an attempt to discover the rvus done to earn the incomes. The true rvu data is needed. I suspect many academics are highly paid per rvu. The chairman is certainly overpaid- vrad and Sheridan hire people for 50K per year to do the administrative tasks. As far as research is concerned most research generated or directed by radiology chairmen is a destruction of wealth ( negative utility).

[charnie]

+1
 

Quote from bcov

The medicare data was an attempt to discover the rvus done to earn the incomes. The true rvu data is needed. I suspect many academics are highly paid per rvu. The chairman is certainly overpaid- vrad and Sheridan hire people for 50K per year to do the administrative tasks. As far as research is concerned most research generated or directed by radiology chairmen is a destruction of wealth ( negative utility).

[Unknown Member]

I have discovered that the CEO of Ford and the Vice Presidents together made no cars at all. 
 
Yet they are paid very large salaries
 
What an outrage
 

[Unknown Member]

Quote from Dr.Sardonicus

I have discovered that the CEO of Ford and the Vice Presidents together made no cars at all. 

Yet they are paid very large salaries

What an outrage

 
False analogy
 
Dr Sardonicus is starting to sound like a pseudo-intellectual- you in academia too?
 
Several factors affect the strength of the argument from analogy:
The relevance (positive or negative) of the known similarities to the similarity inferred in the conclusion.
The degree of relevant similarity (or dissimilarity) between the two objects.
The amount and variety of instances that form the basis of the analogy.
 
An S&P500 corporation is not analogous to a group of radiologists who derive income from mostly government determined fee schedules.
[h3][/h3]  
 

[Unknown Member]

A chairman of a department, like the CEO of Ford,  is not supposed or expected to do production (assembly line) work. A Chairman who is doing significant amount of clinical work isn’t doing the job, and won’t have the job long. He/She is supposed to supply direction and leadership.  Nor are those who do high level research. 
 
Your premise (as best I can make it out) is that the highest earners in the department are making more than their RVU’s would permit. Irrelevant.
 
And no I am not in academia, only did 9 years, 14 publications: too much politics, too many hours. Generally a miserable experience. Much freer in PP. So I did live the academic life, which is why I just shake my head when I see posts saying how easy it is.
Have you any experience working as an academic (i.e. not resident or fellow?)
 
(and please go light on the insults. They degrade the conversation. How about “I think that the analogy may not be accurate…. ” and then go on to explain. Thank you for your consideration of this thought)

[mario.mtz30_447]

I don’t really care how much academic rads make, but how bout we get rid of any oversupply of rads, so we’re ALL better compensated. Or at least slow the cuts down.

[btomba_77]

Quote from IGotKids2Feed

I don’t really care how much academic rads make, but how bout we get rid of any oversupply of rads, so we’re ALL better compensated. Or at least slow the cuts down.

Agreed.
 
I have stated many, many times on this board that rank & file academica radiologists are just as negatively impacted by oversupply as PP rads.  (And are [i]more[/i] negatively impacted by the alternative pathway which directly puts downward pressure on academic salaries).

[antoni.bielazik_633]

Quote from dergon

I have stated many, many times on this board that rank & file academica radiologists are just as negatively impacted by oversupply as PP rads.  (And are [i]more[/i] negatively impacted by the alternative pathway which directly puts downward pressure on academic salaries).

 
Some people on here deny the existence of that pathway like global warming.

[Unknown Member]

[size=”3″]Duly noted. [/size]
 
[size=”3″] What is “leadership and direction” worth? I am well aware of the propaganda flying around an academic radiology department.  [/size]
[size=”3″] Who is paying Chairpersons? Who is paying for research? [/size]
 
[size=”3″] Dr Sardonicus, were those 15 publications worth the time and effort and costs? Did they create value? [/size]
 
[size=”3″] To quote Ben Graham [/size]
[size=”3″] “An investment operation is one which, upon thorough analysis promises safety of principal and an adequate return. Operations not meeting these requirements are speculative.” [/size]
 
 

[Unknown Member]

PP value: RVU’s, accounts receivable
 
Academic value: publications, grants
 
The program in Dallas covers Parkland at night. How much money does the county save by not having to hire in-house attendings or vRad? Those residents are reimbursed by CMS. The chair is ultimately responsible for that system.
 
What’s more, I had not heard of Rofsky until he took over UTSW, replaced all of the section chiefs with people of his ilk, and halted bonus-for-clinical productivity programs. Plenty of his rads have quit because he won’t pay them like the guy before. The taxpayers ultimately benefit, but his national leadership reputation is far from positive. Just ask anyone who has worked there before and after he took over.

[nelson33.jn]

And while we point the fingers at each other, the hospital suits laughter all the way to the bank, lol!

[Unknown Member]

Specialty Certificates Issued 2006-2015 Diagnostic Radiology 
2006- 1,133
2007- 1,162
2008- 1,207 
2009- 1,233 
2010- 1,239  
2011- 1,257 
2012- 1,328
2013- 1,329 
2014- 123*  oral exam changes happened this year
2015- 1,092
TOTAL- 11,103
 I called the ABR to see if alternate pathway certificates were included. They said no. I asked how many alternate pathway certificates were granted and they said that information is not public.
 
transparency, accountability, justice.
 
Corruption?
 
Hmmmm….
 
[link=https://www.theabr.org/sites/all/themes/abr-media/Annual_Report_2015-16-desktop.pdf]https://www.theabr.org/si…rt_2015-16-desktop.pdf[/link]

[antoni.bielazik_633]

Well you can sort of infer from the number of oral exams that took place in 2014.  All of the ACGME residents took the CORE that year.

[Unknown Member]

I am not sure why there is a claim of corruption. What does the number of certificates issued have to do with this?
 
Why do you care how many alternate pathway certificates were issued? Those are people with 8 years of post-graduate training in radiology, the last 4 of which were at a fairly comprehensive accredited American program.
 
I say start by getting rid of the community programs. The alternate pathway does not produce as many radiologists as it used to.

[Dr_Cocciolillo]

Alternative pathway introduces graduates outside of residency.  That’s what is “bad” about it.  It’s extra, uncontrolled supply.  Extra 40 people a year can skew the market in certain geographic areas. 
In no other field in medicine can you simply do “fellowship” work and be grandfathered in.  IF all these people are so great and competitive, they should apply via the residency pathway, not be outside of it.  
and yes, i want to protect my turf and investment into education and my field.  

[Unknown Member]

You best protect turf and educational investment by excluding the least qualified people which are more likely to be the applicants taking the residency spots in undesirable residency programs.
 
The alternate pathway is not uncontrolled supply. They have to be at the same institution all 4 years, and the institutions have to certify their training pathway. You can’t bounce around to 4 different ACGME-accredited institutions anymore.
 
The point of the alternate pathway is that you have to do 4 years at an ACGME-accredited institution which is really not much different than people spending 4 ACGME-accredited years in a residency. These people can be fairly marketable because they often have more advanced training in multiple subspecialties than if they simple did 4 years of residency again.
 
There are IMG’s who occupy community residency programs at great rates in recent years, but their path to a job is more difficult than the alternate pathway. If a physician did a radiology residency elsewhere, it would be redundant to do it again.
 
As for certain geographic areas, the market is already toast with or without alternate pathway graduates.

[Unknown Member]

Just to be more clear, there are too many residents graduating right now, with or without alternate pathway radiologists. This is more prominent in the northeast, so I advocate starting there and slashing the community programs.
 
The Bostonites, Duke, UCSF, Stanford, etc. (I would say Michigan, but I’m told that they don’t certify alternate pathway even if a fellow stays there 4 years) all have enough fellowships and technically enough pathology to provide (reputedly) solid training for a large number of people.
 
St. Vincent (MA and CT), LSU-Shreveport, Baptist (AL and OK), Staten Island, Rochester General, and Aventura, FL are extraneous training programs and should be closed.

[btomba_77]

Quote from Garlic Bread

I say start by getting rid of the community programs. The alternate pathway does not produce as many radiologists as it used to.

 
So would I.  
 
I’m not a big fan of alternative pathway, but small community programs, many of which don’t meet their educational responsibilities, would be my first target too.

[antoni.bielazik_633]

How come we have to do internship and alternative pathway does not?  That’s my biggest issue with it.  It’s a double standard.

[Unknown Member]

IMG’s applying for fellowships have had radiology training before they come to the US. If they do 4 years and possibly an intern year someplace else, they wind up with 4-9 years of postgraduate training compared to 5 for a US LCME graduate.
 
The need for a separate intern year is a different debate, but the ABMS won’t allow the ABR to waive it anyway, so we are stuck with it. Interestingly, New Mexico ended their famous integrated intern year, so the trend is definitely in support of a separate dedicated PGY-1 despite the pleas of Gunderman et al.

[antoni.bielazik_633]

I would fully welcome IMGs in the alternative pathway to join our internships and residency programs.

[Unknown Member]

Apparently surgical specialties have an alternate pathway too. I did not know this.
 
This backdoor approach to potentially destabilizing the market for our services is concerning.  I would rather have across the board medicare cuts. At least jobs would be plentiful in the long run and we (physicians) would be treated with respect by insurance companies, hospitals and private practice groups. A saturated physician market with such a high barrier to entry and sunk costs of 14-15 “overpriced education” years is a disaster for all involved except the executive/bureaucrat/tyrants of the healthcare “system.”
 
[link=https://www.facs.org/~/media/files/quality%20programs/trauma/vrc%20resources/alternate%20pathway%20criteria.ashx]https://www.facs.org/~/me…athway%20criteria.ashx[/link]

[rneelmegh]

People actually trying to defend the alternate pathway boggle my mind.

If 4 years at one institution is “basically like doing a residency” then there should be no objections to actually just doing the residency instead.

Crappy community programs AND the alternate pathway both dilute the field and BOTH should be shut down.

I’ve worked with really excellent alternate pathway folks. They would be just as excellent had they done an actual US rads residency. The rules should apply equally to everyone.

Trying to distract the conversation by denouncing crappy community programs is like trying to argue against global warming by talking about how much it snowed last winter.

[Unknown Member]

IMG’s who do the alternate pathway would not get into the residency programs at the institutions where they do 4 fellowships. You know this.
 
My argument is to preserve training at high quality programs–either residency or fellowship–and eliminate training at low quality programs.
 
The supply/demand problem is more adequately addressed if you shave off 100-200 positions at bad residency programs than if you dumped the 20-40 alternate pathway people every year.

[rneelmegh]

If an IMG is qualified and motivated, why would they be at a disadvantage getting into a quality residency program?
 
Could it be because the “Bostonites, Dukes, UCSFs, and Stanfords” have alternative pathway fellows that function differently than their residents?
 
And if they function differently and therefore have a different experience than the residents at these places, then is it really fair to consider both groups to be equivalent at the end of the 4 years? Is 4 years of exploitation at the academic mecca really the same as 4 years of quality residency training?
 
The alternative pathway contributes to oversaturation of radiologists and exploits IMGs caught up in the system. The only ones who benefit are the unscrupulous academic departments who exploit cheap fellow labor, much like the unscrupulous private practice rads who benefit from residency-affiliated sweat shops.
 
Both systems are equally indefensible.

[henriqueabreu]

To play devils advocate, the IMGs are not exactly victims in it.  They chose that path so “exploited” may not be the right word.  More like a mutually beneficial arrangement.

[henriqueabreu]

As an aside, what kind of jobs do these IMG alternative pathway people end up taking.  Sheridan type positions?

[henriqueabreu]

Or do they go back to their home countries?

[Unknown Member]

hey raises a good point. If they are on J-1 visas, they have to go back to their home country or work in a needy location.

[yamin]

Quote from hey

As an aside, what kind of jobs do these IMG alternative pathway people end up taking.  Sheridan type positions?

The vast majority stay as faculty in the big academic centers. Most of the big academic programs have a good amount of attendings who did the alternative pathway. 

[Unknown Member]

Quote from radsequence

The vast majority stay as faculty in the big academic centers. Most of the big academic programs have a good amount of attendings who did the alternative pathway. 

Do you have evidence that this is a current trend?
 
I agree that this used to be the case a few years back when academic radiologists were in demand, and they were given O-1 visas and such.
 
Trump suspended premium processing for H-1B visas in April, and even with that being the case, FMG’s I have talked to in at least 3 different states tell me that H-1B’s have been soaked up by tech companies over the past 5 years and not gone to doctors as much as they used to.
 
You can’t stay on a J-1 forever.

[yamin]

Quote from Garlic Bread

Quote from radsequence

The vast majority stay as faculty in the big academic centers. Most of the big academic programs have a good amount of attendings who did the alternative pathway. 

Do you have evidence that this is a current trend?

I agree that this used to be the case a few years back when academic radiologists were in demand, and they were given O-1 visas and such.

Trump suspended premium processing for H-1B visas in April, and even with that being the case, FMG’s I have talked to in at least 3 different states tell me that H-1B’s have been soaked up by tech companies over the past 5 years and not gone to doctors as much as they used to.

You can’t stay on a J-1 forever.

 
This is just anecdotal evidence. Having been in 3 different academic institutions over the last years, and also getting to know people in the field through conferences, etc… Where I did residency and fellowship (both considered ‘top programs’), there were multiple attendings (including chief of sections) who had gone through the alternative pathway. 
 
I don’t have any knowledge about what you’re describing in regards to visas. Maybe things have changed now. If that’s the case though, it would affect the ability of FMGs to find jobs altogether since private practices typically don’t sponsor visas. 

[Unknown Member]

I, too, have worked at several academic institutions. I also go to conferences regularly. I agree, there WERE a lot of alternate pathway graduates taking academic jobs from about 2005 to 2012 when there were more jobs. What I am describing are recent decreases.
 
Talking about how many IMG’s you see at conferences is no longer relevant to this discussion because they often got their jobs several years ago.
 
As I stated in other threads, the “top” places are where you are going to find the most alternative pathway graduates because 1) only the “top” programs have 4 fellowships and thus pump out alternate pathway graduates locally and 2) jobs at the “top” places tend to be bad jobs. Just ask anyone on here talking about low salaries in Boston and the California bay area relative to cost of living. If they were good jobs, they would be taken by people who don’t need visa sponsorship.

[Unknown Member]

There are 11 osteopathic programs graduating 1-4 rads per year. I think this has been relatively stable. The osteopathic programs struggle with funding so they haven’t grown. The osteopathic medical schools however have increased dramatically. 22,000 DOs in 1985 and 87,000 in 2014. 8.5% growth rate- unsustainable. 
 
[link=http://opportunities.osteopathic.org/search/search_results.cfm?CFID=3979778&CFTOKEN=2d48d9ccbdda4af-95FD4790-D524-3008-9D7ED077EE8D16EB]http://opportunities.oste…-3008-9D7ED077EE8D16EB[/link]
 
[link=https://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2014-osteopathic-medical-profession-report.pdf]https://www.osteopathic.o…-profession-report.pdf[/link]
 

[Unknown Member]

So now we are graduating too many DO’s?

[Unknown Member]

Some of those DO radiology programs can be quite subpar as far as training goes….

[Unknown Member]

Quote from irinterview2017

Some of those DO radiology programs can be quite subpar as far as training goes….

This is very likely the case, yet the ACGME is accrediting them.

[Unknown Member]

Add the 40 DO rads plus 1330 ACGME rads plus an unknown number of alternate pathways- that’s lots of supply- now combine that with a plateau in imaging….
Why don’t we start certifying England and India too- lol
That would really be the death knell for US radiologists.
 
The VC’s have done their homework. There will be a surplus of rads for the foreseeable future. The private equity “investments” are safe. 

[Unknown Member]

I agree with that sentiment. As long as radiologists need a fellowship to get a job, there is a significant oversupply.

[btomba_77]

Bumping thread…
 
 
 
 
[b]Academia insulated from Economics [/b]
 
Given the explosive meeting we just had over compensation with the hospital president yesterday I just have to laugh at this thread title.

[Unknown Member]

Can you elaborate? This applies mostly to the chairman. The FMGs and other grunts at the bottom actually are underpaid.

[btomba_77]

Elaboration:
 
I think that the title of the thread was laughable on its face and that many of the subsequent comments showed a lack of understanding both of the day-to-day practice of academic radiology and the economic pressures on academic radiologists.

[Unknown Member]

Quote from dergon

Elaboration:

I think that the title of the thread was laughable on its face and that many of the subsequent comments showed a lack of understanding both of the day-to-day practice of academic radiology and the economic pressures on academic radiologists.

I don’t think this is an elaboration but I acknowledge you do not like the thread.
 
Were you asked to work for 20 dollars per wRWU? 😉

[Unknown Member]

Quote from dergon

Elaboration:

I think that the title of the thread was laughable on its face and that many of the subsequent comments showed a lack of understanding both of the day-to-day practice of academic radiology and the economic pressures on academic radiologists.

 
Care to enlighten us?
 
The research component is highly dysfunctional. Medical research should be coordinated at the national level to eliminate duplication and increase sample size. Only useful research should be done when paid for by the tax payers.
 
Why did it take so long for meniscal surgery sham trials to be performed? -it eventually was done in Finland.
Why haven’t more sham trials been done for proximal humeral fracture surgery? Rotator cuff surgery? Spine fusion surgery?
 
Tax payers subsidizing academic rads all over the nation to “publish or perish” is not the way to go.

[Unknown Member]

Quote from drad123

Quote from dergon

Elaboration:

I think that the title of the thread was laughable on its face and that many of the subsequent comments showed a lack of understanding both of the day-to-day practice of academic radiology and the economic pressures on academic radiologists.

Care to enlighten us?

The research component is highly dysfunctional. Medical research should be coordinated at the national level to eliminate duplication and increase sample size. Only useful research should be done when paid for by the tax payers.

Why did it take so long for meniscal surgery sham trials to be performed? -it eventually was done in Finland.
Why haven’t more sham trials been done for proximal humeral fracture surgery? Rotator cuff surgery? Spine fusion surgery?

Tax payers subsidizing academic rads all over the nation to “publish or perish” is not the way to go.

 
The initial post of the thread which you started was about economics of academic practice. Your view appeared to be that some were paid too much. 
I didn’t see a lot of reasoning behind it, just “wow, this seems like a lot”
There was little understanding of what work level in academics or the pay level was like for the usual academic physician.
 
 
And now this post.
Not sure what to make of it except it seems to be a generalized screed against all things academic. 
Has nothing really to do with the economics,  and that issue was discussed thoroughly 2 years ago.
 
What sort of experiences have you had to evoke such passion? This is beyond the intensity that most people feel. Whats up?
 
Perhaps there should be a thread about how to conduct medical research. That is a very timely topic. 
 

[Unknown Member]

Many academics defend low production with academic activity and teaching.
I think it is apropos to question anything and everything in medicine.
Just ruminating on the institution of academic medicine.
I suspect it could be done better.
 
And Dergon, I thank you for your service. This is not a personal attack.
 
 

[consuldreugenio]

A lot of academic programs have ramped on their clinical demands from their physicians. I know a surgeon in an ivory tower that generated revenues of $3M+ last year, not even counting facility fees. His salary is less than 500k. I believe a raise was given to the surgeons to prevent mass exodus.

Many rads are likely the in similar situations. I doubt a rad will generate $3M in professional fees/year though.

[Unknown Member]

Quote from Umichfan

A lot of academic programs have ramped on their clinical demands from their physicians. I know a surgeon in an ivory tower that generated revenues of $3M+ last year, not even counting facility fees. His salary is less than 500k. I believe a raise was given to the surgeons to prevent mass exodus.

 
And THAT is what I was writing about 2 years ago. What an academic doc is paid is usually well less than what he/she brings in. For the reasons I noted then.

[Unknown Member]

Quote from Umichfan

A lot of academic programs have ramped on their clinical demands from their physicians. I know a surgeon in an ivory tower that generated revenues of $3M+ last year, not even counting facility fees. His salary is less than 500k. I believe a raise was given to the surgeons to prevent mass exodus.

Many rads are likely the in similar situations. I doubt a rad will generate $3M in professional fees/year though.

Can you elaborate? At 35 dollars per wrvu this represents 85,714 wrvus. The equivalent of 7 docs.

[consuldreugenio]

The person is a Surgeon, not a rad. Ivory tower, so lots of cash paying patients from foreign countries, private patients etc. complex procedures with high reimbursement. No Medicaid patients allowed. A < one hour procedure could yield multiple thousands in professional fee alone easily. Obviously billing is efficient. Also a few PAs also bringing in cash with his supervision.

Like I said, basically impossible for a rad to match that production. We just read and we dont do fancy expensive procedures. IR can get fancy, but the volume and efficiency are not there.

Academics try to sell research, but they see docs as cash cows. The suits told the surgeon he did ok with his $3M+ production for the year, but could do even better next year (no mention of raise).

[consuldreugenio]

My overall point is that many departments more than cover their salaries in academics. Their salary is not too much. If they arent covering their salaries directly, they are making up for it by referring patients to specialists in the system.

[ranweiss]

I get the DO hate. I am one. 
 
It’s not fair to just clump subpar DO programs into the ACGME. But have some respect for those of us who worked our butts off and matched into ‘MD’ programs, when we had to outperform our counterparts significantly. 
 
Regardless of who / how many of us are training, we are essentially in this fight together vs. AI, vs. alternate pathway, vs. corporates. 
 
Better to band together, I think. 

[btomba_77]

How to compensate/incetivize non-clinical activities is one of the big fights in academic medicine across the board.   Our radiology department is no different.
 
Currently the model for research (which I find unacceptable) is boiled down to “do research on nights and weekends until your CV gets thick enough for promotion”.  At the associate professor level you get a pay bump of the equivalent of more than few single digit percent raise in bases salary and another bump at full professor.  The problem is that in the current environment where the clinical load is so great very few young radiologists will end up choosing that pathway.
 
(If you have funded research/grants to pay yourself for time off of the service that’s another story … but only the big time academics have that going on)
 
_______
 
 
Education is paid for by paying the department a stipend which is the equivalent of a couple percent of salary for every rad that meets a definition of “core faculty” …. which we also fight about.      This isn’t paid to individuals though, it goes to the department budget for global salary support.  Most radiologists teach as a labor of love, without direct compensation.  Despite some degree of minimal support most consider teaching to be a large “unfunded mandate”
 
______
 
Administrative tasks are compensated to the department through an MSA for salary support.
 
How the individual rads see admin as a benefit is by a reduction in their the % FTE status, allowing them to have a lower level of expected clinical production.
 
Section Chiefs, hospital directors, vice chairs all have some degree of reduction in the clinical FTE status for administrative tasks.  We fight about this too …. admin has been ratcheting down on it over the years and many people, especially directors at larger hospitals where administrative tasks take up a lot of time, feel that they would be financially better off just quitting their leadership position and going back in to the reading room to crank out cases all day.
 
______
 
 
 
The hospital administration is looking to move to a new global compensation plan under the CARTS model (Clinical, Administrative, Research, Teaching, Strategic) … I’m sure that will be a big fight too and they will try to nickel and dime us the whole way.
 
 
____
 
Base salary is set annually according to a completely asinine clusterf*ck of a plan  based on your prior years  percentile of clinical performance relative to national benchmarks.
 
 
 
 
It’s a mess …. It’s inadequate to recruit and retain … it angers hard working rads …very few people end up satisfied because the [b]real[/b] comparative benchmark is how our compensation holds up relative to the large similar medical center 20 blocks down the street.   And on a$/RVU basis we are low by at least 25-30%… at least.
 
 
_____
 
 
 
 
 

[Unknown Member]

It’s good to see the rads throwing hissy fits instead of lining up under the steamroller. Sign of things to come. I think the decades old trend of more work for less pay has finally come to an end.

[btomba_77]

Quote from Jimboboy

It’s good to see the rads throwing hissy fits instead of lining up under the steamroller. Sign of things to come. I think the decades old trend of more work for less pay has finally come to an end.

We’re finally coming out of a decade where the hospital leadership could effective say “You want more pay? Tough h*t. There are 30 guys waiting to replace you.”
 
In our region now the dynamics have flipped. At least for now we have a bit of leverage due to supply/demand.  We’ve had enough people quit to get their attention.   We have to effectively use it while we have this hot job market.

[Unknown Member]

Yep – use that leverage while you have it. The trick will be holding on to it.
 
 
One other anecdote occurred to me. This is for drad123, who thinks academics are paid too much. Many years ago, a senior faculty member at UCSF visited us for a couple of days. During the time he was there, we had a lot of conversations. He told me they were having a terrible time at UCSF, because they couldn’t pay enough for assistant professors to afford a 1 bedroom apartment in the city. 

[sanad50_506]

This one tour guide a couple years ago in SF pointed to a 1 bedroom apartment with 8-900 SQ feet and parking on street that goes for 800,00$.
No garage ?!! Wtf

Where I trained at in a community practice that was bought out by a major university 8 years before I trained ..,attendings made almost double what their counterpart made at UCSF.
To live in SF the attending would have to make double of my former attendings to have the same comparable lifestyle.

I can definitely see why they couldnt pay. But they have many great attendings and I love their lectures.

[Unknown Member]

There are many flavors of academics. So really not possible to generalize.
A long time ago, I was in academics. No doubt I read less than my PP counterparts, but there was all sorts of other things I had to deal with; teaching, research etc. 
I liked teaching senior residents and fellows, but any lower, especially med students, was tedious, pedantic and a time sink. Those that can do it cheerfully and effectively have my respect. 
The politics were on steroids though. Sayers law, sometimes attributed to Woodrow Wilson, asserts: “The politics of the university are so intense because the stakes are so low.” That was my experience. Of course, the politics of PP can be severe; but typically limited to $ and RVU’s; and at least in democratic groups, you cannot be whimsically terminated. The capricious politics of academia is exhausting. 
 

[Unknown Member]

The politics were on steroids though. Sayers law, sometimes attributed to Woodrow Wilson, asserts: “The politics of the university are so intense because the stakes are so low.” That was my experience. Of course, the politics of PP can be severe; but typically limited to $ and RVU’s; and at least in democratic groups, you cannot be whimsically terminated. The capricious politics of academia is exhausting.  

They exhausted me. One of the primary reasons I left. I estimated I was spending about 25% of my time with activities directed toward protecting myself. 
 
I always thought that there were layers to the political issues- there were those dealing with the clinical practice. Those exist in PP and academics. And then there were the layers that concerned the chairman, the dean, etc. Those didn’t exist in PP. So it was a much easier ride. 
 
 
 

[btomba_77]

Quote from Dr.Sardonicus

The politics were on steroids though. Sayers law, sometimes attributed to Woodrow Wilson, asserts: “The politics of the university are so intense because the stakes are so low.” That was my experience. Of course, the politics of PP can be severe; but typically limited to $ and RVU’s; and at least in democratic groups, you cannot be whimsically terminated. The capricious politics of academia is exhausting.  

They exhausted me. One of the primary reasons I left. I estimated I was spending about 25% of my time with activities directed toward protecting myself. 

I always thought that there were layers to the political issues- there were those dealing with the clinical practice. Those exist in PP and academics. And then there were the layers that concerned the chairman, the dean, etc. Those didn’t exist in PP. So it was a much easier ride. 

 
The politics are absolutely the biggest downside in my practice.  Have been for 20 years.  I’m not good at them and they give me a stomach ache.
 
 
I try to stay out best I can but now I’ve fallen into this odd position of being the department’s equivalent of the “union rep.”
 
I say what needs to be said on behalf of the rank & file because many of the young rads either lack confidence in their ability to express their opinions or fear drawing the ire of leadership/administration.
 
I have plenty of confidence (whether it is appropriate confidence or not remains to be seen 😉  )  … and a combination of financial independence and lack of ambition for higher position means I do not care whether the people above me like me or not.  
 
 
So … now I’m the guy who says what everyone is thinking. Bluntly.
 
But it takes a toll emotionally.

[julie.young_645]

Well, that happens in PP too, dergon. Been there on several issues over the years. 
 
Coupla things…I’ve never felt I was good enough for academics. There, I said it. I do not have the gift of teaching ability (and it is truly a gift), and I don’t have the patience for research and publication. 
 
I do think many of us out here in flyover PP land (make of that what you will) have the notion that academia is easier than PP, something with which I don’t agree. However, we are also a bit dismayed by the number of academes who function as plaintiff wh0res. I have the perception that they do so in greater proportions than PP rads. I haven’t been able to determine if that is truly the case. 

[Unknown Member]

Dergon, what are your thoughts on chairman compensation? 
How is it determined?
Is it fair?
It seems to be 2-3X the rank and file.
Do they put in more than a 40 hour week?
 
Thanks in advance.

[ljohnson_509]

Dergon, do your arguments ever change things? My experience with this type of setting is that they sometimes acknowledge compensation is too low but theres no money (or willingness) to pay more.

Seems like the academics and admins have gotten very spoiled by the down rad market and are having a tough time accepting the new reality. Its almost as if they choose to ignore the consequences of not being able to recruit and running the department very short staffed and at the brink of disaster.

[btomba_77]

Quote from Drrad123

Dergon, do your arguments ever change things? My experience with this type of setting is that they sometimes acknowledge compensation is too low but theres no money (or willingness) to pay more.

 
Ask me in 8 months.  (That is exactly the horseh*t they’re pulling right now. … time will tell if we can move them)
 

Seems like the academics and admins have gotten very spoiled by the down rad market and are having a tough time accepting the new reality. Its almost as if they choose to ignore the consequences of not being able to recruit and running the department very short staffed and at the brink of disaster.

 
Absolutely.  That describes our situation perfectly. 
 
 
It is isn’t limited to academia though.  PP groups, national telerads, etc also got spoiled.  They have also been slow to adapt to the new reality of the job market.  
 
 

[Unknown Member]

Dergon, 
Your drop in pay over the last decade has probably been synonymous with rising executive compensation. 
Do you think executives are willing to give up compensation so that rads can get paid more?
Consolidation in healthcare has given the remaining executives more power than ever.
At the end of the day no dollars are left on the table.
Getting more money from any players- patient, insurance, hospital, government- is extremely difficult if not impossible.

[Unknown Member]

HIS drop in pay ????
 
I don’t understand why you are so obsessed with academic pay and academic economics.
By far the greater threat is the employment of radiologists by hospital chains or by organizations being run to profit those other than those making the money – either publicly held or held by a small number of radiologists in the group.
In each case, the clear incentive is to minimize the pay to the working radiologist and move that money to others who are not actually earning it. 
 
So I don’t understand the outrage over how some academic centers pay their people. It has zero impact on those of us in the wider world. Is totally irrelevant.
 
Keep your eye on the important stuff.
 

[Unknown Member]

His department’s drop in pay if that makes everyone feel better. Same drop has taken place for PP.
Rad fees lower and insurance, hospital, pharm/device exec comp higher.
 
I exclude IR. They are likely getting a higher base salary and call pay and making more than ever.

[btomba_77]

Great article linked to me by one of our residents (and my future MSK fellow)
 
I’ve been saying exactly this for years….
 
[link=https://www.benwhite.com/medicine/academic-medicine-and-the-peter-principle/]https://www.benwhite.com/…d-the-peter-principle/[/link]
 
[b]Academic Medicine and the Peter Principle[/b][/h1]

 
 
The Peter Principle, formulated by Laurence J Peter in 1969, postulates that an individuals promotion within an organizational hierarchy is predicated on their performance in their current role rather than their skills/abilities in their intended role. In other words, people are promoted until they are no longer qualified for the position they currently hold, and managers rise to the level of their incompetence.
 
 
[b]In academic medicine, this is particularly compounded by the conflation of research prowess and administrative skill. Writing papers and even getting grants doesnt necessarily correlate with the skills necessary to successfully manage [i]humans[/i] in a clinical division or department.[/b] I dont think it would be an overstatement to suggest that they may even be inversely correlated. But this is precisely what happens when research is a fiat currency for meaningful academic advancement.
 

 
This, imho, is the main reason for poor leadership in academic radiology departments.
 
 
 
 

[Unknown Member]

Who pays?
 
Where does the chairman comp come from? reading fees of other rads lower on the pyramid? Hospital technical component? research grants? Hospital general fund? No one knows….
 

[Unknown Member]

Are academic rads just subspecialty rads? Are subpecialized large groups “academic level” like some claim to be- American Radiology Group in Dallas for instance?
 
The buzzword for the next decade in radiology is Academic.
 
Every patient in the US deserves an academic radiologist interpretation. We can do better as a nation. 

[btomba_77]

Quote from drad123

Who pays?

Where does the chairman comp come from? reading fees of other rads lower on the pyramid? Hospital technical component? research grants? Hospital general fund? No one knows….

 
The budget of an academic radiology department is quite different from that of a smaller private practice.
 
It is not directly tied to the revenues brought in by the department.  The hospital administration decides how much to pay the chair in the same way they decide how much to pay the rank & file radiologists.
 
It is a negotiation between the chair thinking about accepting the position and the person doing the hiring as the performance benchmarks and expectations, just as it is in most executive hiring scenarios. 
 
I’m honestly not sure why this seems to be baffling/upsetting to you.
 
_______________________
 
 

Quote from drad123

Are academic rads just subspecialty rads? Are subpecialized large groups “academic level” like some claim to be- American Radiology Group in Dallas for instance?

The buzzword for the next decade in radiology is Academic.

Every patient in the US deserves an academic radiologist interpretation. We can do better as a nation. 

The term “academic rad” does not have a single definition.  Some radiologists consider themselves academic because they publish, some because they lecture, some because they run trials, some because they teach, some simply because their employment is with an academic medical center.
 
Subspecialization is common in academic radiology departments but nowhere near universal. Nor is supspecialization a prerequisite to being an academic radiologist.
 
 
 
 
 
 

[Unknown Member]

Quote from dergon

Quote from drad123

Who pays?

Where does the chairman comp come from? reading fees of other rads lower on the pyramid? Hospital technical component? research grants? Hospital general fund? No one knows….

The budget of an academic radiology department is quite different from that of a smaller private practice.

It is not directly tied to the revenues brought in by the department.  The hospital administration decides how much to pay the chair in the same way they decide how much to pay the rank & file radiologists.

It is a negotiation between the chair thinking about accepting the position and the person doing the hiring as the performance benchmarks and expectations, just as it is in most executive hiring scenarios. 

I’m honestly not sure why this seems to be baffling/upsetting to you.

 
Dergon, from your posts you seem like a cool guy I would enjoy working with.
 
So the radiology chairman is branded as more of a hospital executive than a physician. AAARAD lists chairman comp 50th percentile as 670k in 2021.
 
50th percentile for faculty 410k in 2021 median wrvu 9000
 
The economics of academia is far from simple and I think it is fair to ask questions about it.
 
The old pp model was more simple- collections plus subsidies if any minus expenses divided by rads equals pay plus benes.
 
 
Based on AAARAD data academic radiology is significantly more expensive for a hospital system than pp.
 
 
 

[Unknown Member]

Removed due to GDPR request

[btomba_77]

Yes. The radiology Chair is an executive.
 
When one of my friends and colleagues became the chair of a very prestigious Baltimore area academic medical he shared his FTE status with me.
 
0% clinical
0% research
100% administrative.
 
 
The modern academic chair is running a multi multi million dollar business. Their effectiveness or lack therof  in running that opearation outweighs by orders of magnitude the revenue they could generate by reading films.
 
I do *not* want my Chair in the reading room any more than is necessary to keep up their skills/ credentials/licensure.
 
I want them out at some dinner party hitting up some mega-donor so that I can become the beneficiary of  the Distinguished (and endowed) Julius K. Moneybags Professorship in Musculoskeletal radiology. 
 

[Unknown Member]

May you be distinguished and well-endowed

[Unknown Member]

Our distinguished Chair of Radiology gave a lecture one evening, honoring the mega-donor for whom a “chair” was being established.  Great pomp and circumstance, as one can imagine.
 
Then, when the Chair designated the recipient of the newly-founded “chair,” he gave it to himself…
 
Enough said?
 

[petitegrandepoubelle_264]

As an academic rad, this thread was incredibly depressing. Thanks guys.

[ranweiss]

I can guarantee…not only the chair of radiology , but also likely the chairs of various radiology subspecialty departments…are getting at least 50% admin time, and like much more, for ‘administrative tasks’ – and are making twice or more than the highest paid regular rad. The chair is easily in the 7 figs.  they get more vaca and perks…
 
it’s really the only reason to stick in academics. Still absolutely not worth it from a fiscal perspective, given the chances of getting that high up in leadership. 

[Unknown Member]

I trained at a residency where a significant minority of every class stayed on in academics. The ones I knew had good reasons to choose an academic career and money was clearly not one of them.

I have a lot of respect for academic radiologists in general, and am grateful for what they do. Probably because of the kindness and genuine interest of the ones who taught me and mentored me, incredibly smart and accomplished physicians who had no ulterior motive to invest additional time in teaching me and using their connections to benefit me.

[Unknown Member]

Envision took over an academic facility in Detroit. RP Baylor. I wonder if this has happened at other places?
 
I wonder how this works.
 
I assumed that most academic practices were subsidized by the institution.  Is the chairman employed by Envision or RP?
 
I assume the physician services company will ask for subsides plus management fees.
 
Does RP or Envision pay based on AAARAD data? No way for RP or Envision to make money with just pro fees doing that.
 
 

[consuldreugenio]

Thats probably their problem. They are probably wanting 15k wrvus/year from academic rads used to producing 9k. Wont fly for long.

[Unknown Member]

Academics should not be about money. It should be about teaching, research, leadership and the integrity of our field. However, I also agree that academic rads should be fairly compensated. 

[Unknown Member]

This is a graph that explains a lot. Was shown at the RSNA a few years back by Vivian Lee.

[btomba_77]

Like any organization the quality of leadership is highly variable.
 
About 2x rank & file is pretty standard. 
 
I use the ETEE acronym for my expectations of department leadership.
 
[b]E[/b]thical, [b]T[/b]ransparent, [b]E[/b]ffective,  [b]E[/b]quitable  – If leadership meets those goals I don’t begrudge them their $$.
 

 
They tend to put in a lot of hours both at the hospital and at “events.”
 
How effective they are however, isn’t really based on how many hours they put in. (see above)
 
A modern radiology chair needs to be part politician, part CEO, part union boss, part rainmaker …. to do it well is a tough gig.
 
 
 

[Unknown Member]

Quote from dergon

Like any organization the quality of leadership is highly variable.

About 2x rank & file is pretty standard. 

I use the ETEE acronym for my expectations of department leadership.

[b]E[/b]thical, [b]T[/b]ransparent, [b]E[/b]ffective,  [b]E[/b]quitable  – If leadership meets those goals I don’t begrudge them their $$.

They tend to put in a lot of hours both at the hospital and at “events.”

How effective they are however, isn’t really based on how many hours they put in. (see above)

A modern radiology chair needs to be part politician, part CEO, part union boss, part rainmaker …. to do it well is a tough gig.

Not sure if this means more than 40 hours.
So the chairs work evenings, weekends and holidays?
They tend to have no clinical responsibilities so why can’t admin duties be done 9-5. Hospital admin certainly maintains those hours.

[Unknown Member]

However, we are also a bit dismayed by the number of academes who function as plaintiff wh0res. I have the perception that they do so in greater proportions than PP rads. I haven’t been able to determine if that is truly the case.

That have noticed the same.

[Unknown Member]

Quote from dergon

Like any organization the quality of leadership is highly variable.

About 2x rank & file is pretty standard. 

I use the ETEE acronym for my expectations of department leadership.

[b]E[/b]thical, [b]T[/b]ransparent, [b]E[/b]ffective,  [b]E[/b]quitable  – If leadership meets those goals I don’t begrudge them their $$.

They tend to put in a lot of hours both at the hospital and at “events.”

How effective they are however, isn’t really based on how many hours they put in. (see above)

A modern radiology chair needs to be part politician, part CEO, part union boss, part rainmaker …. to do it well is a tough gig.

Could you provide a quick summary as to what a chairman does? 
Equipment and techs are almost certainly managed by hospital.
Radiologist hiring and firing?
Rad schedules?
Research supervision- whatever that means.
Rainmaker? A person who generates new business? How does this happen?

[Unknown Member]

Quote from dergon

Like any organization the quality of leadership is highly variable.

About 2x rank & file is pretty standard. 

I use the ETEE acronym for my expectations of department leadership.

[b]E[/b]thical, [b]T[/b]ransparent, [b]E[/b]ffective,  [b]E[/b]quitable  – If leadership meets those goals I don’t begrudge them their $$.

They tend to put in a lot of hours both at the hospital and at “events.”

How effective they are however, isn’t really based on how many hours they put in. (see above)

A modern radiology chair needs to be part politician, part CEO, part union boss, part rainmaker …. to do it well is a tough gig.

So chair compensation is fair in your opinion?

[btomba_77]

Yes, if the job is done competently.
 
No, if not.

[Unknown Member]

Quote from dergon

Yes, if the job is done competently.

No, if not.

The median annual wage for chief executives was $189,600 in May 2018.
[link=https://www.bls.gov/ooh/management/top-executives.htm]https://www.bls.gov/ooh/management/top-executives.htm[/link]
 
Radiologists already receive executive level compensation. Double pay is not warranted.
 
Do you also think your University hospital CEO pay is justified? I will guess he makes much more than your chairman.

[Unknown Member]

Many chairpersons are narcissistic. They need validation. They like the events, the travel, etc. Its a lot of hours, but they are hours geared towards stroking their ego.
Even with potential psychopathology, they can do a good job. Its their wheelhouse.

There are many fantastic clinical rads who would be a terrible chairperson, because their head is not into that game.

Of course, there are the few exceptional leaders who one might follow thru fire. Cant count on that though.

Chairpersons are like football coaches, it has to do with those who surround them.
Also, they come and go, like coaches. Chairman do get fired, or pushed out. And when they do, there is a tumult. The princes are beheaded, and new ones are brought in.

The democratic PP is typically dysfunctional and cliquey. Water cooler melodrama, but not as overreaching as academics. Power is diluted. Tragedy can be avoided if one follows the Tao.

[Unknown Member]

Are you discriminated against in Chicago as a DO?

[Unknown Member]

Quote from Umichfan

Many rads are likely the in similar situations. I doubt a rad will generate $3M in professional fees/year though.

 
I am glad you doubt this. It demonstrates at least a modicum of understanding.

[Unknown Member]

Drad,

You raise some good questions. Its hard to quantify what a good chairperson is worth or even what criteria decides what makes a good chairperson.

In my somewhat limited experience, a good chairperson is reflected in the department. When the department functions well and people are generally getting along, the chairperson is likely decent. When every day is Game of Thrones, the chairperson probably isnt great.

I would venture that a good chairperson is worth a very large amount of money. Keeping people happy and productive generally leads to better retention, more production both in RVUs and research, and a variety of other positive effects.

Having a good leader is like having a good nights sleep. The world just seems brighter and better with one. And like a good nights sleep, one doesnt always notice it until one doesnt have one. And then man, one would pay quite a lot to have it again.

[Unknown Member]

Quote from radgrinder

Drad,

You raise some good questions. Its hard to quantify what a good chairperson is worth or even what criteria decides what makes a good chairperson.

In my somewhat limited experience, a good chairperson is reflected in the department. When the department functions well and people are generally getting along, the chairperson is likely decent. When every day is Game of Thrones, the chairperson probably isnt great.

I would venture that a good chairperson is worth a very large amount of money. Keeping people happy and productive generally leads to better retention, more production both in RVUs and research, and a variety of other positive effects.

Having a good leader is like having a good nights sleep. The world just seems brighter and better with one. And like a good nights sleep, one doesnt always notice it until one doesnt have one. And then man, one would pay quite a lot to have it again.

I this is the case and radiologists are such an unruly bunch why not let RP or Envision take over- they will have a low paid administrative assistant on site- likely and old radiology director- it’s cheaper.
 
I wonder how Envision is managing the Detroit academic group? legacy Imaging Advantage
Is there still a chairman?
Does he still make 2-3X rank and file?

[Radscatter]

Per doc revenues greater than 3M are obtainable in an outpatient Interventional practice (depending on the case mix).  Now profits are a different matter[8|]
 

[Radscatter]

I think another issue is that the docs with the most power to affect what we get paid per study/procedure are members of the AMA RVS Update Committee (RUC). These are the people that help determine and argue the value of what we do with other medical specialities. The money pot is fixed. Any raise in payment to radiology gets taken from another speciality. Unfortunately, the vast majority of the members of the RUC from radiology are in academia. Their incentives do not align with those of us in PP. Many other specialities require a significant portion of their RUC members to be from PP (for obvious reasons). Many of the cuts we have had in the past are directly related to weak representation on this panel by academic types. 

[Unknown Member]

A lot of academic institutions are busy as all get all with really sick patients. Dreary cavernous institutions. Crap vacations. Some places its a commute just getting to your parking spot.
Not easy.

[laurence.stewart]

I think another issue is that the docs with the most power to affect what we get paid per study/procedure are members of the AMA RVS Update Committee (RUC). These are the people that help determine and argue the value of what we do with other medical specialities. The money pot is fixed. Any raise in payment to radiology gets taken from another speciality. Unfortunately, the vast majority of the members of the RUC from radiology are in academia. Their incentives do not align with those of us in PP. Many other specialities require a significant portion of their RUC members to be from PP (for obvious reasons). Many of the cuts we have had in the past are directly related to weak representation on this panel by academic types.

Not sure what this means. The pot is fixed. How are incentives misaligned? Are you suggesting that a PP representative would be more persuasive that another specialty should give up some RVUs so they can be added to rads? Both academics and PP rads would seem to benefit from the pursuing the same actions within the committee.

[william.wang_997]

I would say that we need less mammo and less neuro rad representation in these meetings. A PET CT scan is now being compensated the same as contrast CT AP , the last I heard. 
 
quote=Stat_Manatee]

I think another issue is that the docs with the most power to affect what we get paid per study/procedure are members of the AMA RVS Update Committee (RUC). These are the people that help determine and argue the value of what we do with other medical specialities. The money pot is fixed. Any raise in payment to radiology gets taken from another speciality. Unfortunately, the vast majority of the members of the RUC from radiology are in academia. Their incentives do not align with those of us in PP. Many other specialities require a significant portion of their RUC members to be from PP (for obvious reasons). Many of the cuts we have had in the past are directly related to weak representation on this panel by academic types.

Not sure what this means. The pot is fixed. How are incentives misaligned? Are you suggesting that a PP representative would be more persuasive that another specialty should give up some RVUs so they can be added to rads? Both academics and PP rads would seem to benefit from the pursuing the same actions within the committee.
[/quote]

[laurence.stewart]

Wouldnt that be a good thing? That would seem to be highly valuing the quick and easy CTAP relative to the PET-CT. Wouldnt that benefit both groups? Maybe even favoring PP?

[Radscatter]

Quote from Stat_Manatee

Wouldnt that be a good thing? That would seem to be highly valuing the quick and easy CTAP relative to the PET-CT. Wouldnt that benefit both groups? Maybe even favoring PP?

 
Thing is payments don’t go up. They only go down. We only ‘win’ if our sh1t doesn’t go down as much as everyone else’s. 

[Unknown Member]

If you say that PET-CT is being reimbursed low compared to brain MRI, nobody is going to increase the RVU for PET-CT. They will decrease the RVU for Brain MRI. That is how the system works. 

[laurence.stewart]

The pot is fixed though, right? So we would lose if our RVU pie slice decreased relative to other specialties? It seems to me that every type of radiologist would lose from that outcome and the real skill in these committees would be making persuasive arguments to the group as a whole about the relative value of the most commonly performed procedures.

[Unknown Member]

Quote from Robotrad

Quote from Stat_Manatee

Wouldnt that be a good thing? That would seem to be highly valuing the quick and easy CTAP relative to the PET-CT. Wouldnt that benefit both groups? Maybe even favoring PP?

Thing is payments don’t go up. They only go down. We only ‘win’ if our sh1t doesn’t go down as much as everyone else’s. 

 
^^ Unfortunately this is how it works these days. 
 
Unless there is some form of seismic shift in the way we practice, there is little chance for a windfall.
 
Radiology was initially, ~50 years ago, profitable because no one understood it. And so we were paid generously. “They” have figured it out. Who is going to fight for radiology to be paid better? We really don’t have any allies; so it on us. We are a small part of medicine; it doesn’t look promising.
 
And so we read faster and faster, and pretend we can make up for it with volume and “efficiencies.”
 
Oy.

[laurence.stewart]

The mechanics of this committee seem very interesting. The overall pie is decreasing (? thats just an assertion, dont have any data to back that up) and there really wouldnt seem to be any real allies among the pie holders because its a zero sum game. Every one has the same goal and the game would seem to be simple – hold on to what you have and never change. Is it a democracy? Where does the momentum for change actually come from? Do they vote on things?

Maybe you could try to get a little piece of someone elses pie, but who grants it to you? Do they debate relative value, if so, to whom? Are the members passive to the dictates of a central committee (e.g. Find a way to cut your pie slice by 3%, we dont care how). Who appoints the leadership? The actual mechanics would seem really important.

There seems to be occasional assumptions that there is collusion against radiology, which I suppose would be possible, but it would involve collaboration between groups that dont always get along that well and its not like they would necessarily directly benefit from, say, chest CT losing 0.2 RVU. So it seems like the strategy would be to influence whoever overall committee leadership is to deflect cuts away from your pie and cut someone else, but who appoints these supremely powerful people? They must have some conflict of interest since they come from some specialty.

Such a strange process, since it seems to rely on all doctors working together for the good of the whole. I guess no better way to do it? At least none that comes to mind right now.

[laurence.stewart]

This thread has inspired me to read up more about how this RUC actually works.

[william.wang_997]

Looks like neuro and mammo are eating up the whole pie relative to other studies / modalities. And now they are bossing everyone around and hogging most resources and salaries in the hospitals in comparison to other radiology subsp. This is not rules based ( how much time is it needed to do the study and read it , Brain MR vs whole body PET CT), but force and politics and committee rules based ( they have more people rooting for their subsp. and trashing other ).. But then even the UN doesnt work that way, so everyone just carries on. Dont look up !!
 

Quote from Stat_Manatee

The mechanics of this committee seem very interesting. The overall pie is decreasing (? thats just an assertion, dont have any data to back that up) and there really wouldnt seem to be any real allies among the pie holders because its a zero sum game. Every one has the same goal and the game would seem to be simple – hold on to what you have and never change. Is it a democracy? Where does the momentum for change actually come from? Do they vote on things?

Maybe you could try to get a little piece of someone elses pie, but who grants it to you? Do they debate relative value, if so, to whom? Are the members passive to the dictates of a central committee (e.g. Find a way to cut your pie slice by 3%, we dont care how). Who appoints the leadership? The actual mechanics would seem really important.

There seems to be occasional assumptions that there is collusion against radiology, which I suppose would be possible, but it would involve collaboration between groups that dont always get along that well and its not like they would necessarily directly benefit from, say, chest CT losing 0.2 RVU. So it seems like the strategy would be to influence whoever overall committee leadership is to deflect cuts away from your pie and cut someone else, but who appoints these supremely powerful people? They must have some conflict of interest since they come from some specialty.

Such a strange process, since it seems to rely on all doctors working together for the good of the whole. I guess no better way to do it? At least none that comes to mind right now.

[Radscatter]

Quote from RADD2010

I would say that we need less mammo and less neuro rad representation in these meetings. A PET CT scan is now being compensated the same as contrast CT AP , the last I heard. 

quote=Stat_Manatee]

I think another issue is that the docs with the most power to affect what we get paid per study/procedure are members of the AMA RVS Update Committee (RUC). These are the people that help determine and argue the value of what we do with other medical specialities. The money pot is fixed. Any raise in payment to radiology gets taken from another speciality. Unfortunately, the vast majority of the members of the RUC from radiology are in academia. Their incentives do not align with those of us in PP. Many other specialities require a significant portion of their RUC members to be from PP (for obvious reasons). Many of the cuts we have had in the past are directly related to weak representation on this panel by academic types.

Not sure what this means. The pot is fixed. How are incentives misaligned? Are you suggesting that a PP representative would be more persuasive that another specialty should give up some RVUs so they can be added to rads? Both academics and PP rads would seem to benefit from the pursuing the same actions within the committee.

 
Many in academia only do committee work in order to move up from Assistant/Associate to full professor or to move up the ranks of ACR. In their eyes that is the only way to increase their pay and more importantly their academic bonafides. Many of these types take on revaluation projects just for the ‘glory’ of being in charge of the project. They don’t understand the PP value of the technical fees that many PP get when owning their own imaging centers or OBL/ASC. In fact many academic types may have a perception that radiologists that own their own means of production make too much. It can be very difficult to properly value these cpt codes. Everything used in the study/procedure needs to be properly valued. If the cost of labor/staff, real estate, or supplies goes up and the RVUs do not adjust than we will lose money. It is of utmost importance that we have are brightest and most motivated minds in radiology on these panels. 

[laurence.stewart]

Thats interesting. You always wonder where some of the super low discordant valuations come from. I would have thought that the hospitals would be interested in keeping the technical fees and that would have filtered into the academic equation.

Maybe someone on here remembers, since it was before my time does anyone remember what motivated the major event of bundling CT abdomen and CT pelvis? Hard to imagine that was an academic idea or an ACR initiative. Stories make it seem like it was externally imposed, but who just decided to do that? Just dreamed up by a non rad chair of the RUC committee and then voted on? How does something like that just happen?

[Unknown Member]

Quote from drad123

Many academics defend low production with academic activity and teaching.
I think it is apropos to question anything and everything in medicine.
Just ruminating on the institution of academic medicine.
I suspect it could be done better.

 
Why do you care if academics have “low production”??   Really??
Again – you appear to have no experience whatever. In my academic experience, I produced just as much as a PP doc, and I had to teach, and I had to publish.
When I went to PP one of my new partners somewhat condescendingly said “Well, I suppose you find it pretty busy here?” He was speaking from a position of total ignorance. So, I told him that really, it was like a vacation. And I told him that I did just as much clinical work in my academic job, but had two other jobs. 
 
I am sure that some academics would arrogantly assume they could tell you how to run a PP better, also 
 
 

[ruszja]

Sounds low for Texas.

[Unknown Member]

Quote from fw

Sounds low for Texas.

Texas is highly corporate- 350k 8 weeks, q 3 weekend 12000 wrvu is the standard deal.

[Unknown Member]

Quote from Dr.Sardonicus

And BTW, the OP cherry picked the data (something we learned in academia was a deceptive practice). 
Here is the data for the 68 assistant professors -not just the top 10 earners in the department:

cherry picked the data (something we learned in academia was a deceptive practice)
 
I’m proud of your discovery of cognitive bias Dr.Sardonicus. 
 
By the way your data supports my claim of high inequality in the failing institution of academic medicine- the bottom is lower and the top higher than private practice. LOL

[mario.mtz30_447]

Quote from dergon

Thanks, Sard.

But you know that in reality we’re all really just ghost-signing reports generated by unsupervised slave residents and underpaid alternative pathway fellows while we luxuriate on our yachts.

My secret plan is to destroy our profession from within.  I personally control all of the residency programs in the nation and am responsible, along with my other sinister colleagues, for all of the over-training of residents.

I intentionally fail to educate them so that my enemies in private practice are saddled with underperforming schlubs.  Instead I have them toil in the barium fields from dawn to dusk, learning nothing but padding my gigantic high six-figures academic salary.

I never teach or prepare conferences. I never attend multi-disciplinary tumor boards. I never review multiple imaging studies free of charge for sarcoma patients transferred in from the outside.  I never do any of that stuff.   It’s all boat all the time.

I do all of this from the inside, hastening the demise of our field. I am the Manchurian Academic Radiologist.

 
Yeah, you kid, but I bet the members of SCARD could actually do something to protect our field if they wanted to.  
 

[Unknown Member]

I doubt that, given the recent flood of radiology practices either being bought (or just taken over) by hospitals and also the sell-outs to entrepreneurs. 
 

[Unknown Member]

Quote from Nibbler

Just saw this thread and figured I chime in some, months later. 

Rad dept makes money off of the technical side as well. Just not professional billing.  Plus there are grants, etc.  Not sure how that figures into everything. 

 
Rad dept makes money off of the technical side as well.
 
Any evidence to support this claim or was it born of immaculate conception?

[Unknown Member]

Quote from Feigner

If PP pays $650K or $700K in your market like Oklahoma City, and you take less than half that to work for OU, yeah, that’s a sacrifice.

You can make a lot more than that with vRad, Aris, etc. if you put the elbow grease in.

If you are in New England making $300 a day, that’s a different story, but they have been over-training radiology residents there for years.

If PP pays $650K or $700K in your market like Oklahoma City 
 
they don’t
 
You can make a lot more than that with vRad
 
You can’t

[Unknown Member]

You are worth what they pay you. 
 
This is a tautology SP333. 

[CT128]

580 for a chairman? That is way lower than expected. Rofsky’s real world practical contributions in body MR and the excellent training he has given to fellows easily warrants that comp at minimum.
 
Do you have personal beef with him?
 
I agreen that academia is in disconnected from private practice in that there are too many rads being minted and the selectivity of applicants has taken a dive.

[btomba_77]

I didn’t take it personally.   
 
But I do take issue when people on the forum attempt to either a) paint all academics with a broad brush as lazy or overpaid or somehow scamming the system or b) blame all of the problems in the radiology profession on academics.
 
 
I am waist deep in the economics of a modern radiology department.  I can tell you that I am very much aware of economic pressure… on recruitment, retention, academic production, education, quality and service.
 
To somehow claim that academics are “insulated” from the economic (and inexorably interlocked volume/productivity) pressures is just flatly untrue.
 
 

[Unknown Member]

Quote from dergon

I didn’t take it personally.   

But I do take issue when people on the forum attempt to either a) paint all academics with a broad brush as lazy or overpaid or somehow scamming the system or b) blame all of the problems in the radiology profession on academics.

I am waist deep in the economics of a modern radiology department.  I can tell you that I am very much aware of economic pressure… on recruitment, retention, academic production, education, quality and service.

To somehow claim that academics are “insulated” from the economic (and inexorably interlocked volume/productivity) pressures is just flatly untrue.

Thanks for pointing out my ignorance.
Without getting into specifics at your hospital could you explain how teaching and research are priced?
Who decides how much time to allot to teaching and who pays for it?
Who determines what research gets done and who pays for it?
Is there a website that addresses this?
 
I have wondered how much transparency there is in an academic department.