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How Radiologists Are Paid: An Economic History, Part IV: End of the Bubble
[size=”3″] JACR: [/size]
[size=”3″] Abstract [/size]
[size=”3″] During the first decade of the 21st century, the imaging bubble began to burst. The combination of digitized images, the DICOM standard, and affordable PACS sharply increased radiologists productivity but also allowed an imaging study to be read from anywhere, creating the field of teleradiology and increased competition for radiologists. Increasing numbers of insurers contracted with radiology benefits managers to help control radiology utilization, and the Deficit Reduction Act of 2005 mandated spending cuts across the government. Consolidation of multiple Current Procedural Terminology codes and the reassessment of calculations used to estimate the utilization of a CT or an MRI scanner exerted additional downward pressure on radiology reimbursements. [/size][size=”3″] All of these factors, combined with more radiologists completing residency and the delayed retirement of older radiologists after the 2008 financial crisis, brought the imaging bubble to an end. [/size]
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57 Replies
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With incomes at all time highs, I dont know if I would characterize the bubble being popped when it comes to pay.
Maybe in PP ownership and TC money…..
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Golden era of Rads has certainly passed. Current era is still OK but as above we work harder for less money. Sheer volume keeps income high for now but the trend is not our friend.
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Quote from CoronaRad
…..we work harder for less money…….
I feel like this applies to most jobs. Dishwasher or Doctor
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Pay per case dropping every day
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The next era of rads will be the coming of AI and rad extenders. Be ready for a HUGE drop in demand.
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Well if that’s happens, maybe blame the 500K a year, lattes and 26 weeks of vacation….
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It changes by maintaining &/or regaining ownership in every situation possible
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The beginning of the end was the point at which more radiologists (and physicians) were hired [i][b]BY[/b][/i] MBA’s than the other way around.
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Quote from Apathetic&luvinit
It changes by maintaining &/or regaining ownership in every situation possible
I just don’t see it happening. Rads are outmaneuvered and outgunned by business savvy suits nationwide. Rad margins are basically getting crushed.
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the key is to either 1) retain control of billing so you continue to avoid a skim job 2) work for a system that is willing to still pay you 55/wrvu b/c they can collect $90 wrvu.
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I believe the beginning of the proverbial end was the selling off of the technical portion and thereby forfeiting the technical component. I do agree controlling billing is the key but how many clinics/hospitals etc would agree to that?! They will find a rad to read for the per click fee in a heartbeat
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Quote from wisdom
the key is to either 1) retain control of billing so you continue to avoid a skim job 2) work for a system that is willing to still pay you 55/wrvu b/c they can collect $90 wrvu.
Or to always be looking for a higher paying job because someone is always looking (and also be in i a position to leave).
Thankfully the number of new grads is still relatively small compared to the size of the field.-
There was never a bubble. I agree golden era has ended and will never be seen. The only way to see the golden era would be to own the patients, harness AI and use it to speed up reads…unfortunately AI will be used by corporates and hospitals to slowly push radiologists out of the equation. We still make good money, but have to work very hard for it. Telerads at 20/rvu very hard to make good money, I think I’d rather be a hospitalist than be paid telerad rates. Why do you rads accept these extremely low rates by Vrad and other strictly telerad companies? Are you cannon fodder?
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With all these changes and complexities, overall incomes may be going down, but I have also heard it is becoming more equal among radiologists (PP vs academics, partner vs employee/associate, and telerads) compared to 10-15 years ago. Not sure how accurate that info is.
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Agree with relative equalization of the incomes. It has already happened and not only in radiology. It is across the board. Look at salaries of physicians of different specialties in big cities. There is relative equalization between academic centers and private practice in every field and even the salaries of different specialties are getting closer to each other with very few exceptions like spine surgeons or orthopods. Otherwise, the days that family docs make 150K and Rads and GI make 700-800K are gone, at least in big and mid size cities. Not uncommon for primary care to make 250-300K in big cities and not uncommon for GI or rads to take jobs that pay 350-400K.
Another step towards socialization of medicine.
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Quote from Hospital-Rad
Agree with relative equalization of the incomes. It has already happened and not only in radiology. It is across the board. Look at salaries of physicians of different specialties in big cities. There is relative equalization between academic centers and private practice in every field and even the salaries of different specialties are getting closer to each other with very few exceptions like spine surgeons or orthopods. Otherwise, the days that family docs make 150K and Rads and GI make 700-800K are gone, at least in big and mid size cities. Not uncommon for primary care to make 250-300K in big cities and not uncommon for GI or rads to take jobs that pay 350-400K.
Another step towards socialization of medicine.
What I would like to see is this – a non-zero-sum game.
FP 700k
Surgeons 700k
Radiologists 700k
Administrators – 70kPrimary care was evsicerated in the 80s and 90s. Unfair, and not helpful to medicine as a whole.
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Sounds like we gave up and continue to give up autonomy for short-term income and lifestyle, and thus the farm was sold and we were deprived of all three.
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Lol 700k, that’s out of touch.
Biden is up 14 points so get ready for a 200k salary like in Germany.
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Quote from avocado
Lol 700k, that’s out of touch.
Biden is up 14 points so get ready for a 200k salary like in Germany.
I have to second this. Very unrealistic.
200k can still provide a great life in may areas of the US away from big cities and the coasts. -
200k with 6 figure loans and a start in your 30s can provide a miserable life in many parts.
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Hence there should be no loans, and no overtraining. 4 years med school right after high school, 2-4 year residency and you’re a physician. Extra 1-2 years fellowship if needed for more advanced work (highly optional).
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Quote from avocado
Hence there should be no loans, and no overtraining. 4 years med school right after high school, 2-4 year residency and you’re a physician. Extra 1-2 years fellowship if needed for more advanced work (highly optional).
Why not eliminate fellowships? They are a big part of the overtraining problem.
Want to do neuroradiology or interventional neuroradiology? Go into it after med school. -
Quote from drad123
Quote from avocado
Hence there should be no loans, and no overtraining. 4 years med school right after high school, 2-4 year residency and you’re a physician. Extra 1-2 years fellowship if needed for more advanced work (highly optional).
Why not eliminate fellowships? They are a big part of the overtraining problem.
Want to do neuroradiology or interventional neuroradiology? Go into it after med school.
Because that model only works in academics. It’s great in that setting, but in the majority of practice, a neuroradiologist needs to be able to read a chest CT, ultrasound, plain film. Neuro IR is likely an exception bc most of those guys just do NIR.
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The later start is the key.
In my neighborhood the housing prices have almost doubled in the last 10 years. In other words you have to make twice as much to buy similar house.
I thick they won’t decrease the doctors salaries. Better ways exist which include:
1- Not increasing the salaries so the real saddleries will go down due to inflation. This has happened in the last 15 years2- Increasing taxes for high middle class earners
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Quote from Dr.Sardonicus
What I would like to see is this – a non-zero-sum game.
FP 700k
Surgeons 700k
Radiologists 700k
Administrators – 70kPrimary care was evsicerated in the 80s and 90s. Unfair, and not helpful to medicine as a whole.
Curious that administrators’ salaries are downgraded to just national median income while maintaining high 6 figures for physicians. This is a huge difference in incomes, 10x higher for physicians? Based on? It shows the bias of perceived importance.
This is part of the problem, a definite zero-sum game where incomes are minimal for everyone under the physicians and physicians preserving their high incomes at their “lessers'” expense. Administrators do not need to earn $500k but $70K? Are they just running a local retail or fast-food franchise? And this does not compare benefits between positions. And if administrators make only $70k, those under administration make even less.
“$1 for you, $10 for me….” -
I dont mind MBAs making good salaries if they are working for US. I DO mind them making $2M and OWNING us.
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It doesn’t make sense for anyone to work for a practicing physician. Physicians have their own roles as employees of the organization. Management has their own roles too.
Arguing that somebody should work for physicians is like arguing that retail employees should own Walmart because the stocked some shelves. Sounds good, doesn’t work.
If physicians want to own anything they should transition into management / entrepreneurship, which is a different profession from practicing medicine.
There are still some physician left who are partners rather than employees, but that’s a relic of the past that’s going away now that we have more advanced technology and economies of scale when it comes to delivering healthcare at retail prices.
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Quote from avocado
Arguing that somebody should work for physicians is like arguing that retail employees should own Walmart because the stocked some shelves. Sounds good, doesn’t work.
On the contrary, there are many employee-owned businesses that are successful. There are even highly successful corporations where those people who “only” stock shelves can sit on the corporate boards and make decisions about the corporation.
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Except for years, decades, people have been complaining that the problem with medicine was that it was not being run like a business. Now we have corporate medicine being run like corporate businesses. The purpose of healthcare is like any other business, profits.
This is what was planned for and implemented for a couple of decades now. It’s not that much of a surprise. Add de-regulation to the mix and things get more towards corporate control.
And regarding those MBA’s and CEO’s earning multiple millions in income, what businesses ever pay the subordinate employees more than the controlling business people? I am not aware of any that pay an employee more than the CEO or MBA’s in the C-suite, etc. In corporate-think, you are the employee and it is the business people who know better how to run the business and therefore they get paid more in compensation.
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I’m not against taking the profit motive out of the system by adding a public option option Frumi. It works in many other countries with better outcomes.
It’s still going to be run by technologists and executives, not by doctors, because the system needs to be actually functional.
Doctors will get paid for their work but it’s going to be in line with other rich nations (100-250k depending on type of work). Medical education will be debt-free.
It’s common sense reform that’s inevitable because it works everywhere else.
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i have made this point over and over again. pay, in general, is higher in the US vs other western countries. this is true for small business owners, electricians, assembly line workers, roofers, you name it.
PAs and RNs should then make 60k a year if that’s going to be the scale. admins, 100k. -
Of course PAs and Nurses would make less than physicians. That’s how it works in other countries too. Lots of different professions would lose $$$ (and many “professions” would disappear altogether). The point is to shrink the entire pie, not just the 10% consumed by physicians.
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Never argue this sort of thing with Socialist doctor-haters. My bad.
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Sure. Lets shrink what everyone makes in the US and eliminate earning power and jobs. Then, the corporations and stock holders can really start making some money.
And we css as n build some really elaborate lobbies and new hospitals -
Check this out
[link=https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/]https://www.healthsystemt…u-s-compare-countries/[/link]
[link=https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/]https://www.healthsystemt…u-s-compare-countries/[/link]
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[link=https://www.medscape.com/slideshow/2019-international-compensation-report-6011814]https://www.medscape.com/…nsation-report-6011814[/link]
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The overall market is disheartening for new grads with extremely high student loan burdens (over 500k) and what seems like increasing amounts of work for less pay.
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The outcomes in the United States can be accounted overwhelmingly by
1. Obesity and lack of social stigma to be obese, not to mention personal accountability. Its always the fault of the system
2. Teenage pregnancy and promoting the birth of extreme pre mature babies
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We’re like rats trained to press the pedal to “feeeed meeee” more.
Regarding personal accountability, you would be able to easily some morbidly obese people willing to engage you on that, agreeing that the problem is a lack of people’s personal responsibility.
American obesity did not just happen. There is a culture. Have to change the culture, this one is all about consumption. And sugar is cheap. -
Covid was an end to the healthy radiology job market of last 3-4 years.
We will see another 5-6 years of tough market, similar to what happened around 2009-2015.
The volumes (in large scale) won’t be back to preCovid for another year and the groups will be resistant to hire for another 3-4 years.
So unfortunately the job market has entered a period of stagnation that can’t last for several years.
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and above and beyond those two, rates of adverse early childhood experiences (the cause of most of humanities grief).
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Quote from Frumious
Quote from Dr.Sardonicus
What I would like to see is this – a non-zero-sum game.
FP 700k
Surgeons 700k
Radiologists 700k
Administrators – 70kPrimary care was evsicerated in the 80s and 90s. Unfair, and not helpful to medicine as a whole.
Curious that administrators’ salaries are downgraded to just national median income while maintaining high 6 figures for physicians. This is a huge difference in incomes, 10x higher for physicians? Based on? It shows the bias of perceived importance.
This is part of the problem, a definite zero-sum game where incomes are minimal for everyone under the physicians and physicians preserving their high incomes at their “lessers'” expense. Administrators do not need to earn $500k but $70K? Are they just running a local retail or fast-food franchise? And this does not compare benefits between positions. And if administrators make only $70k, those under administration make even less.
“$1 for you, $10 for me….”
I agree Admins don’t need to make 500k, but how can you justify
Employee or associate Rad at a PP making 50-40% of partner income while reading 80 or 100% or in some malignant practices 110% of what partner reads ? Is that justified? What is something so great that the partner doing which justifies that differential in salary ?
Assistant Prof at an academic institution making 300 whereas as the Chair making 600 and/or the vice chairs making 500 by doing lot less work (both clinical and other).
Corp CEOs making millions whereas Rads in the trenches working like in sweat shops?
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A situation where most every associate radiologist makes partner within a few years and is earning 4-500K in the city is a far better situation than corporate radiology where the radiologist can never become the CEO making millions.
It is as egalitarian as it gets in the world we live in. Expecting on day one – where you don’t know where the bathroom is much less know any of the clinicians and have not yet proven yourself – to make as much as a partner because you are reading as much or more volume is asking a bit much IMO. -
In my experience over many years of practice, the new associates overestimate their value to the group. Many of them are great but they are never comparable to a partner who has been in the group for 5-15 years.
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Quote from Hospital-Rad
In my experience over many years of practice, the new associates overestimate their value to the group. Many of them are great but they are never comparable to a partner who has been in the group for 5-15 years.
Why do you allow them to overestimate their value? because as a partner, you prob have not justified the reasons to value yourself. Therefore, you need open discussions and metrics to prove your value to the company. You can’t just say, I am a partner and have been here for 15 years, so I am better than you. Longevity doesn’t always translate to better quality.
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@ Voxel 77
It’s about their perception. The first month, that they start they don’t see what’s going on behing the scene.
Example: I was the person who started PET in our hospital. It was a lot of work. We have established a great working relationship with oncologists and our volume is booming. Igo to tumor boards every week and they call me for my second opinion all the time. I have worked closely with our techs and do all kind of quality controls.
Now a new associates joins our group and opens a PET scan and with his “Ivy league” mindset, dictates a 3 page report which half of it is academic masturbation and he thinks my reports are crappy because they are one page without 9 impressions. Also he thinks that the studies appear on the list out of nowhere. So naturally he thinks he adds 3x value as I do.I can go on and on and talk about a new breast imager with fellowship from Ivy league with 29% call back rate who can not run a tumor board the way that breast surgeons expect but still thinks that the other breast imagers who are not fellowship trained are losers because they use “density” in their report that is not a BIRADS lexicon.
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Quote from Voxel77
I agree Admins don’t need to make 500k, but how can you justify
Employee or associate Rad at a PP making 50-40% of partner income while reading 80 or 100% or in some malignant practices 110% of what partner reads ? Is that justified? What is something so great that the partner doing which justifies that differential in salary ?
Assistant Prof at an academic institution making 300 whereas as the Chair making 600 and/or the vice chairs making 500 by doing lot less work (both clinical and other).
Corp CEOs making millions whereas Rads in the trenches working like in sweat shops?
I don’t. I never have. I was addressing Sardonicus’ wage schedule proposal for unnamed administration positions being 10x lower than a physicians’ salary.
Reality is that work load and even job importance is often, almost never reflected in the position’s salary. Comparing CEO’s salary to the wages of their regular workers is the problem, very many of these regular workers making not mid or high 6 figure incomes but $10/hour with no benefits like paid time off or health insurance, etc.
There are very many malignant jobs out there that do not pay close to 6 figure incomes. -
Quote from Voxel77
but how can you justify
Employee or associate Rad at a PP making 50-40% of partner income while reading 80 or 100% or in some malignant practices 110% of what partner reads ? Is that justified? What is something so great that the partner doing which justifies that differential in salary ?
Yes, I can.
In a true PP, the employee rad started out with a lot to learn. And for this argument, our employees will eventually become partners. That sweat equity will more than pay off for the group and the employee. The newly grad rad needs to learn radiology in practice. Even the seasoned rad need to learn the practice, the politics of the hospital, the many critical things that is not in a text book or a paper, the relationships with ordering physicians. There will be daily or weekly examples of, “I would do this…instead of that…” which actually means, [i]in order to be a partner, you (the employed rad) would do this…instead of that… [/i]I learned the same way as an employee/associate. It is not one of those, [i]since I did this, and so would you [/i]mentality. I did need to learn that during my time. From the employee times, the group/partners will know who they will share the spot in the trench with. I truly believe that partners need to add value to the group. Of course, radiology expertise is a critical one but also, there are other non-radiologic skills/strategic roles that can strengthen the group. We have not let go a full time employee for a few decades, before and during my time. Not all of them stay, but they were all offered partnership. -
Quote from Hubcap
Quote from Voxel77
but how can you justify
Employee or associate Rad at a PP making 50-40% of partner income while reading 80 or 100% or in some malignant practices 110% of what partner reads ? Is that justified? What is something so great that the partner doing which justifies that differential in salary ?
Yes, I can.
In a true PP, the employee rad started out with a lot to learn. And for this argument, our employees will eventually become partners. That sweat equity will more than pay off for the group and the employee. The newly grad rad needs to learn radiology in practice. Even the seasoned rad need to learn the practice, the politics of the hospital, the many critical things that is not in a text book or a paper, the relationships with ordering physicians. There will be daily or weekly examples of, “I would do this…instead of that…” which actually means, [i]in order to be a partner, you (the employed rad) would do this…instead of that… [/i]I learned the same way as an employee/associate. It is not one of those, [i]since I did this, and so would you [/i]mentality. I did need to learn that during my time. From the employee times, the group/partners will know who they will share the spot in the trench with. I truly believe that partners need to add value to the group. Of course, radiology expertise is a critical one but also, there are other non-radiologic skills/strategic roles that can strengthen the group. We have not let go a full time employee for a few decades, before and during my time. Not all of them stay, but they were all offered partnership.Do the corps need to learn the politics of the hospital and establish relationships with the ordering physicians before they take over?
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Quote from drad123
Do the corps need to learn the politics of the hospital and establish relationships with the ordering physicians before they take over?
As your quote, I responded to a very specific question about employee (in a partner track PP) vs partners.
We have been peripherally approached by corps, but nothing materialized.
Your question and my intention to answer a specific question may be tangential. I will take that question of yours at its face value. Do you think corps don’t learn about all that prior to take a bite at a business ? You don’t think that there is a dedicated team at corps, whose job is solely to perform due diligent, networking to hospital and physicians, the rad group make ups, payers environment, simulation analysis…? The fact that they are successful at what they do (I am not saying they are successful at running a radiology practice regarding the medicine aspect) throughout the country indicates that they may know more about groups and the groups of themselves.
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Quote from Hubcap
Quote from drad123
Do the corps need to learn the politics of the hospital and establish relationships with the ordering physicians before they take over?
As your quote, I responded to a very specific question about employee (in a partner track PP) vs partners.
We have been peripherally approached by corps, but nothing materialized.Your question and my intention to answer a specific question may be tangential. I will take that question of yours at its face value. Do you think corps don’t learn about all that prior to take a bite at a business ? You don’t think that there is a dedicated team at corps, whose job is solely to perform due diligent, networking to hospital and physicians, the rad group make ups, payers environment, simulation analysis…? The fact that they are successful at what they do (I am not saying they are successful at running a radiology practice regarding the medicine aspect) throughout the country indicates that they may know more about groups and the groups of themselves.
I am sure they meet with administration. I am sure they ask for payer mix data. Doubt it goes much farther. Do you have first hand knowledge otherwise?
How do you explain the entire US border with Mexico taken over by corporates? Worst payer mix in the country. -
“The business of private equity firms is precisely to increase shareholder value by any means: productive improvements but also squeezing existing stakeholders such as workers, suppliers, or customers.”
-Appelbaum, Eileen, and Rosemary Batt. 2014. Private Equity at Work: When Wall Street Manages Main Street. New York: Russell Sage Foundation, 2014
Productivity increases? Are shackled rads more productive? Doubtful
Out of network billing- customers
Higher private insurance rates? doubtful- suppliers
Lower Radiologist pay? 20 dollars per RVU?- workers
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Quote from Takayasu
Quote from Apathetic&luvinit
It changes by maintaining &/or regaining ownership in every situation possible
I just don’t see it happening. Rads are outmaneuvered and outgunned by business savvy suits nationwide. Rad margins are basically getting crushed.
Or being hung out to dry by Boomers who would rather pad their already fat retirement accounts by closing partnership ranks and selling their ownership stakes to PE rather than pass on the profession to their younger peers.
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don’t forget the ineptitude of the ABR and the ACR, as well as, the radiology extender providers in the form of radiology assistants and the influx of foreign radiologists who were allowed to short cut the system in order to practice in the US
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How does this change in the next 2-3 years?
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you tell me
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