Radiology Future

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Originally Posted by auburnO5

Just curious, but what is your definition of "huge?"

Not sure if it would be worth it to be making $150k.

Why not?

I don't think it will drop that far, but if you really wouldn't be happy being a radiologist at a primary care salary, you should probably look somewhere else.

I'd rather be paid $600k than $100k, but I'd rather like what I'm doing at $100k than be miserable at $600k. And really, we're talking the difference between $250k and $450k, which is an even easier decision.

Originally Posted by johnnydrama

Why not?

I don't think it will drop that far, but if you really wouldn't be happy being a radiologist at a primary care salary, you should probably look somewhere else.

I'd rather be paid $600k than $100k, but I'd rather like what I'm doing at $100k than be miserable at $600k. And really, we're talking the difference between $250k and $450k, which is an even easier decision.

I agree with you, I just think for that salary I can find another specialty that I also like that has better reimbursement (assuming the 150k thing). I don't think it will drop to 150k either.

Originally Posted by auburnO5

I agree with you, I just think for that salary I can find another specialty that I also like that has better reimbursement (assuming the 150k thing). I don't think it will drop to 150k either.

You're thinking the wrong way.

Choose your specialty, not your salary. That's the only way you can be sure you won't regret your choice.

Originally Posted by johnnydrama

You're thinking the wrong way.

Choose your specialty, not your salary. That's the only way you can be sure you won't regret your choice.

Again, I agree with you. I just literally have no idea how to pick my specialty at this point.

Originally Posted by auburnO5

Again, I agree with you. I just literally have no idea how to pick my specialty at this point.

That's because you have no idea about medicine, and that's normal.

Students have zero clue about what is actually interesting and rewarding in medicine. The only things they can really ask themselves about a career choice are:

1. Do I loathe it with fiery contempt?

2. How much does it get paid?

3. How much effort do I really want to put in to get this career?


The balance between these factors are what drive medical school career choices. No student can realistically say that they want to go into X because of a "calling" or because they like it. They just don't have the experience.

Originally Posted by Substance

That's because you have no idea about medicine, and that's normal.

Students have zero clue about what is actually interesting and rewarding in medicine. The only things they can really ask themselves about a career choice are:

1. Do I loathe it with fiery contempt?

2. How much does it get paid?

3. How much effort do I really want to put in to get this career?


The balance between these factors are what drive medical school career choices. No student can realistically say that they want to go into X because of a "calling" or because they like it. They just don't have the experience.

So.... what do you recommend?

Originally Posted by auburnO5

So.... what do you recommend?

Choose something that interests you and that you won't hate doing (not necessarily the same thing).

You can't predict salary, so my advice would be to find something you'd be happy doing for $100k and then just hope it will be reimbursed more.

Aside from shallow cosmetic stuff, the only salaries that are probably completely future proof are the surgical/procedural ones. These come with other trade offs (free time, stress, unpredictable hours, high divorce rate).

As a student, you first goal should be to try to get a sense of what the specialties actually do and if it would drive you nuts.

Originally Posted by auburnO5

So.... what do you recommend?

If you have some spare time, just look at the attending forums: every specialty can be generically describe as such:

Specialty X used to be better in 80's/90's, but no one knows what it will be like in 10 years
Specialty X is getting more competitive each year
Specialty X is in a fight with specialty Y and/or mid-levels for territory
People in specialty X are glad that they aren't in specialty Z, because obviously, things look way worse for specialty Z
Everyone is messing their pants because new drug Q/procedure Q will be out in a few years, and it's going to improve specialty X for the better
Several residents/fellows/attendings in specialty X post about how horrible it is, but there are also posters who rave about how wonderful it is

CareersInMedicine has some tools that might be helpful in figuring out what specialty best fits your interests, personality, and goals

No need to over-complicate things...

Residency selection works like a free market. The most competitive specialties are the best based on all of the important decision-making factors including future prospects. Although things could change, major market fluctuations are gradual and happen over decades rather than years.

To simplify your decision-making, start with the most competitive specialties and start weeding them out based on your own preferences and idiosyncracies. It is just a process of elimination and then a cost-benefit analysis to settle any ties.

Rads is in a very good position because it is both innovative and well-differentiated. To compare it to its brother specialty, as it were, rad onc is in a metastable position because while innovative, it is not well-differentiated at all and a single major cut to their primary modality would be disastrous. The "innovative" part is less well understood, but the specialties with the highest IQs, most resources, and most industrial involvement will likely be more innovative.

It is also important to consider that any specialty with a small number of doctors will have limited political clout (e.g., derm, ophtho, ENT, or rad onc, among others) but at the same time, will not be a major target for reimbursement reductions. Still, this latter consideration is not a major factor since the MedPAC (or w/e it's called) works on a percentage basis...so if dermies are 1% of docs and derm costs grow to 4%, they begin cutting reimbursements.

Originally Posted by johnnydrama

Choose something that interests you and that you won't hate doing (not necessarily the same thing).

You can't predict salary, so my advice would be to find something you'd be happy doing for $100k and then just hope it will be reimbursed more.

Aside from shallow cosmetic stuff, the only salaries that are probably completely future proof are the surgical/procedural ones. These come with other trade offs (free time, stress, unpredictable hours, high divorce rate).

As a student, you first goal should be to try to get a sense of what the specialties actually do and if it would drive you nuts.

Agree with all you said other than the future proof salaries.
A knee replacement used to pay amost 6 times of waht it is reimbursed now 15years ago.
A CABG used to pay almost 3 times of now in 80s.
A cataract surgery was reimbursed 3-4 times of now in late 80s.
An angioplasty/stenting used to pay almost 4 times of now in late 90s.
The same is true for ofice visits, inpatient consults, ...
My main point is that these decreased fees do not only belong to us and they usually cause a transient shock in market. You can ask about GI market around year 2000 when government decreased their fees for colonoscopy significantly and everybody was talking about doom and gloom.
If you are a medical student you will enter the market in 8 years and will be in the market for the next 8-38 years. So deciding on your career in 20 years based on what happened yesterday is not reasonable.

Originally Posted by shark2000

Agree with all you said other than the future proof salaries.
A knee replacement used to pay amost 6 times of waht it is reimbursed now 15years ago.
A CABG used to pay almost 3 times of now in 80s.
A cataract surgery was reimbursed 3-4 times of now in late 80s.
An angioplasty/stenting used to pay almost 4 times of now in late 90s.
The same is true for ofice visits, inpatient consults, ...
My main point is that these decreased fees do not only belong to us and they usually cause a transient shock in market. You can ask about GI market around year 2000 when government decreased their fees for colonoscopy significantly and everybody was talking about doom and gloom.
If you are a medical student you will enter the market in 8 years and will be in the market for the next 8-38 years. So deciding on your career in 20 years based on what happened yesterday is not reasonable.

Yeah, didn't really mean to say future proof in the absolute sense, just that procedural stuff will always have at least some billing advantage over diagnostic.

So if you really wanted to be in the highest earning specialty, you'd need to be ready to gown up.

You're absolutely right that those specialties can face cuts too, I was just being sloppy with language.

I view the gigs as a chance to have a little more to invest and save. Certainly, I'd love to get paid tons of money to do what I love, but I also never planned on medicine being where my real money was made. I always viewed it as giving me enough expendable income to invest in other opportunities.

I believe diagnostic radiology reimbursement will eventually be tied closer to the patient and overall turnaround of reads. There are places that they won't get the official read until a few days later, long after the window of opportunity closed on having any impact on treatment. Those situations probably won't get reimbursed or it will be minimal relative to a faster turnaround time.

Originally Posted by johnnydrama

You're thinking the wrong way.

Choose your specialty, not your salary. That's the only way you can be sure you won't regret your choice.

But if you can't choose your specialty, choose your salary and your time, and GTFO ASAP once you've made a good little nest egg for yourself.

Originally Posted by Substance

But if you can't choose your specialty, choose your salary and your time, and GTFO ASAP once you've made a good little nest egg for yourself.

If that is your mindset, Medicine is not for you and you will be miserable very soon. You have to assume you are going to work the next 20-30 years.

But, agree on something. If you can not choose, see what is the most annoying part of each field as it will get worse over time. So if for you continuity of care is annoying, go to the fields that do not have it. If lifestyle is important, go to some specialties with no weekend or night work, which radiology is not one of them for sure.

Originally Posted by shark2000

If that is your mindset, Medicine is not for you and you will be miserable very soon. You have to assume you are going to work the next 20-30 years.

But, agree on something. If you can not choose, see what is the most annoying part of each field as it will get worse over time. So if for you continuity of care is annoying, go to the fields that do not have it. If lifestyle is important, go to some specialties with no weekend or night work, which radiology is not one of them for sure.