Family Life in Rads

If you want to be taken seriously, you need to stop with the smilies.

Rads is one of the best lifestyle fields out there. If you want to practice medicine and have a family life, it's definitely a good way to go

f1re11 said:

Rads is one of the best lifestyle fields out there. If you want to practice medicine and have a family life, it's definitely a good way to go

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Still true, but this is becoming increasingly less so. The bottom line is you should choose what you love, do what you have to do to make it through residency, and then adapt your practice to your desired lifestyle.

I read that radiologists work an average of 55ish hours per week. I was wondering if you think it's this high because they want to make more money or are those the hours a radiologist has to work to land a good PP job? I know this is what I want to go into, but I wonder how feasible it will be for me to get an 8-5 job (possibly only 3-4 days a week in the future), considering the cost of malpractice? Any thoughts?

There are plenty of other people closer to this topic than I am, so hopefully they will chime in as well...

In general, I think people tend to overcomplicate this. At present, the market for radiologists will allow you to find a job working banker's hours, but you're not going to make $500K doing that. And you certainly won't do it living on the coasts. Simply put, there's no free ride. You'll close some doors with this approach, since most places are looking for future partners who will be incredibly productive for the sake of the practice. But, as of now, you can still do it.


As reimbursement goes down and supply catches up with demand (assuming it will), I think you'll find those opportunities go away. Practices will want their new hires to be serious worker bees to maintain the bottom line in light of the reimbursement cuts. Couple that with more competition as residencies churn out more residents, and practices will have more leeway to hire people willing to put in the hours. You get the idea.

The caveat is teleradiology, which I admittedly don't know as much about as I'd like to. I would think though that if you're willing to work nights, then you could command more of a salary than a similar number of work hours put in while the sun is up.

The 800-pound gorrilla in the room, as usual, is government funded healthcare. Right now the big offender is Medicaid, although I think Medicare may be involved as well depending on how the funding is allotted (not sure). Medicaid, I know, is state run (albeit using lots of federal dollars), so they are becoming less and less willing to pay a teleradiologist. The issue is a legal one, involving where the source of the healthcare product lies.

My understanding of the issue goes like this:
-California Medicaid patient gets CT scan at 10pm in California
-CT scan is read by a teleradiologist licensed in California but living in Hawaii
-Medicaid decides that the healthcare product originated in Hawaii
-Medicaid decides not to pay for CT scan

Again, I'm no lawyer, but that's my cursory grasp on things. Regardless of future trends, it remains a simple equation. Work harder and be willing to go where the money is and you'll have plenty of opportunities to buy that boat. Take it easy and insist on staying in one place and you'll be more likely to have to take what you can get.

Thanks for the reply, colbgw. I admit one of the reasons rads is so appealing is the flexibility it offers, so it would be a huge bummer if I end up having to work 50-60 hour weeks rather than having the option. But good to know of all the possibilities.

Does the good family life come only in private practice with rad?

You're going to work your tail off in many/most fields of medicine. That being the case and the prevailing assumption, I'd rather it be in rads than in surgery, medicine, or whatever.

SarahMadison said:

Does the good family life come only in private practice with rad?

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No. Typically academics allows for better hours, but with a large decrease in pay.

I agree. A lot of fields are somewhat cyclical in nature and Rads appears to be towards the higher end of the cycle right now: demand high relative to supply. It's very likely that payments/procedure will continue to decline and it's also possible for the demand/supply imbalance to even out a bit.

I also second the notion that you should enjoy the field you go into. Don't go into something just b/c you think the pay is high relative to the number of hours and overall difficulty of the job. A buddy from my school made a joke that, through ESP or some other force, students who scored 240+ on Step 1 fell in love with the visual, integumentary or otolaryngology systems overnight!

Rads and Derm are two of the hottest fields right now. There have been some posts from an experienced Attending on the Derm forum also implying that people should enter Derm for their interests in the field, instead of the high pay/relatively relaxed lifestyle. It's been seeing some noticeable reimbursement declines as well; no specialty is immune. Those that are hot may stand to lose more (% basis) than others.

I'm going into rads because I would rather shoot myself than pre-round, round, write H&P and progress notes, play social worker, stand for 14 hours a day, be sprayed with body fluids, or take call (something which I won't do as an attending).

Hopefully, there are positive aspects of Rads drawing you to the field vs avoidance of what you dislike about other fields.

Look at the voluntary attrition in BigLaw and Finance/I-Banking. A lot of them make a lot more money much sooner than Radiologists and still choose to leave. Plus, it's much easier for them to do other sorts of work than for Physicians to leave practice (and they can make the decision at much younger ages).

SarahMadison said:

Does the good family life come only in private practice with rad?

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As has been already stated, the attendings at the training programs tend to have a cushier schedule. Heck, they've got residents that do a majority of the work.

abcabc1 said:

I agree. A lot of fields are somewhat cyclical in nature and Rads appears to be towards the higher end of the cycle right now: demand high relative to supply. It's very likely that payments/procedure will continue to decline and it's also possible for the demand/supply imbalance to even out a bit.

I also second the notion that you should enjoy the field you go into. Don't go into something just b/c you think the pay is high relative to the number of hours and overall difficulty of the job. A buddy from my school made a joke that, through ESP or some other force, students who scored 240+ on Step 1 fell in love with the visual, integumentary or otolaryngology systems overnight!

Rads and Derm are two of the hottest fields right now. There have been some posts from an experienced Attending on the Derm forum also implying that people should enter Derm for their interests in the field, instead of the high pay/relatively relaxed lifestyle. It's been seeing some noticeable reimbursement declines as well; no specialty is immune. Those that are hot may stand to lose more (% basis) than others.

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I don't buy this argument. I keep hearing things are cyclical but are they really?

Is there ever going to be a time again when primary care fields like IM, FM, and Peds are going to match or exceed income levels of rads/derm/ent/plastics/radonc etc?

I just don't see it.

Primary care won't match the hot fields, but the hot fields are no less susceptible to legislation that lowers the payment per procedure or rising practice costs than primary care and other specialties. The supply/demand imbalance is a major factor, but some new programs are popping up and established programs have taken on additional residents so this may change as well. The point was that, just because something is the popular/it field right now, does not mean it will stay that way forever. It wasn't that long ago that Rads and Derm weren't considered that great; it may not be that long until that is the case again.

The caveat is that people should choose Radiology if they enjoy the specialty, for example the technology, procedures, being more of a consultant, etc. Don't do it just b/c you think you can make a lot and not work that much.

Dakota said:

Look at the CT surgeons. 15 years ago they had the highest incomes in medicine. Now the average new graduate gets an offer of $200,000. (1) No, the average FM doesn't make more than the average CTS, but they probably do if you look at it on a per hour basis.

(1) http://ats.ctsnetjournals.org/cgi/content/full/82/3/1160

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If you take into account the hours per week that CT surgeons work (at least 100), they probably would have been better off working at McD's.

Even if they shave off the salary for rads by 1/2, I would still go into it.

I'll be very happy sitting in my Aeron chair, drinking my latte, talking into my dictaphone, working 9-5.

abcabc1 said:

Primary care won't match the hot fields, but the hot fields are no less susceptible to legislation that lowers the payment per procedure or rising practice costs than primary care and other specialties. The supply/demand imbalance is a major factor, but some new programs are popping up and established programs have taken on additional residents so this may change as well. The point was that, just because something is the popular/it field right now, does not mean it will stay that way forever. It wasn't that long ago that Rads and Derm weren't considered that great; it may not be that long until that is the case again.

The caveat is that people should choose Radiology if they enjoy the specialty, for example the technology, procedures, being more of a consultant, etc. Don't do it just b/c you think you can make a lot and not work that much.

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I agree that lifestyle and salary should not be primary driving factors.

But I still haven't seen an answer. If primary care isn't going to see a resurgence, what's going to replace rads/derm/surgical subspecialties etc... at the top of the food chain?

NPR said:

I agree that lifestyle and salary should not be primary driving factors.

But I still haven't seen an answer. If primary care isn't going to see a resurgence, what's going to replace rads/derm/surgical subspecialties etc... at the top of the food chain?

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I'm eager to see what everyone else thinks too. What are the up and coming fields that will replace today's in 10 - 15 years?

vir0n said:

I'm eager to see what everyone else thinks too. What are the up and coming fields that will replace today's in 10 - 15 years?

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Pathology - personalized medicine; molecular diagnostics; digital pathology (ie. PACS/telepathology); rapid throughput genetics-based tests (microarrays)

Rehab Medicine - chronic disease management on the rise; we are living longer

Primary Care ruled by PA's and NP's - it's happening right now.

I agree that things tend to be somewhat cyclical, and I stand by my previous statement that you shouldn't assume hours will be cushy and pay high forever. On the flipside, however, radiology is in good shape to continue leveraging technology to stay on top of the throughput increases required to maintain pay. It's hard to squeeze in another surgery when your hands only work so fast... but increases in efficiency through organization, display, data linking, and dictation will help radiologists do "more work" without burning that much more midnight oil. And if you just must burn the midnight oil, I'd rather it be from my own home than standing in the OR.

Pay will probably come down. That's fine. I just hope it stays good enough long enough to pay off these ridiculous student loans... after that I don't give a rat's ass what it does so long as I can pay the bills.

Taurus said:

Graduates initially seeking jobs reported the salary they accepted or would accept was between $150,000 and $250,000 in 70% of the cases, with the average salary being approximately $194,000. The average salary actually obtained by those residents gaining a job was $202,500. A slight majority (51%) reported this salary as being adequate.​

If you take into account the hours per week that CT surgeons work (at least 100), they probably would have been better off working at McD's.

Even if they shave off the salary for rads by 1/2, I would still go into it.

I'll be very happy sitting in my Aeron chair, drinking my latte, talking into my dictaphone, working 9-5.

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Keep in mind those figures probably represent base salaries without benefits (insurance, production incentives, etc.) unless I missed it in skimming the article. I'm sure the number that you put on your tax return is significantly larger.

schan said:

Pathology - personalized medicine; molecular diagnostics; digital pathology (ie. PACS/telepathology); rapid throughput genetics-based tests (microarrays)

Rehab Medicine - chronic disease management on the rise; we are living longer

Primary Care ruled by PA's and NP's - it's happening right now.

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Hmm...interesting. I did not see those two gaining steam but your explanations do make sense.

The primary care thing is sad though. I'm not handing my medical degree for a nursing degree anytime soon.

Certain fields may stay at the top of the pecking order in Medicine, but they maybe significantly less lucrative in the future than they are now or were in the recent past. Working at Morgan Stanley is still nice, but not as nice now as in the recent past. A large portion of any Physician's revenues and income (assuming they accept Medicare and Medicaid) is government controlled. Private insurance companies tend to follow suit (direction wise), while still paying more than Government.

Its been said that Derm and Rads are two of the specialties that have procedures higher on the list with regards to declining future reimbursements. This is somewhat anecdotal, though.

My feeling is that Path will do well in the future. PMR might improve, but it may not catapault that high. I could see Path incorporating more Tech, Informatics etc. Supposedly it's a lot of Science (gene therapy, etc.) that will be a major factor as Medicine moves forward. Not that there isn't a lot of Science involved now.

abcabc1 said:

Working at Morgan Stanley is still nice, but not as nice now as in the recent past.

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Cost-Cutting in New York, but a Boom in India

vir0n said:

I'm eager to see what everyone else thinks too. What are the up and coming fields that will replace today's in 10 - 15 years?

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I agree with Pathology, I think it's going to hit a critical mass shortage in a few decades when old pathologists retire and there aren't enough young ones to replace them. Not a lot of people go into pathology now because I've heard it's hard to find a good job and probably just decreased interest.

abcabc1 said:

I agree. A lot of fields are somewhat cyclical in nature and Rads appears to be towards the higher end of the cycle right now: demand high relative to supply. It's very likely that payments/procedure will continue to decline and it's also possible for the demand/supply imbalance to even out a bit.

I also second the notion that you should enjoy the field you go into. Don't go into something just b/c you think the pay is high relative to the number of hours and overall difficulty of the job. A buddy from my school made a joke that, through ESP or some other force, students who scored 240+ on Step 1 fell in love with the visual, integumentary or otolaryngology systems overnight!

Rads and Derm are two of the hottest fields right now. There have been some posts from an experienced Attending on the Derm forum also implying that people should enter Derm for their interests in the field, instead of the high pay/relatively relaxed lifestyle. It's been seeing some noticeable reimbursement declines as well; no specialty is immune. Those that are hot may stand to lose more (% basis) than others.

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Despite any "cuts" derm may take, derm will always be hot because of the shortage of derms in this country. Month long waitlists to see a dermatologist is proof of this. So, as long as the number of trainees shelled out each year remains at the same level it's been, derms will always be a great field to go into if you want to make the big bucks...and have some biz/entrepreneurial sense.

KeratinPearls said:

Despite any "cuts" derm may take, derm will always be hot because of the shortage of derms in this country. Month long waitlists to see a dermatologist is proof of this. So, as long as the number of trainees shelled out each year remains at the same level it's been, derms will always be a great field to go into if you want to make the big bucks...and have some biz/entrepreneurial sense.

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.....not to mention it is a cash business. doesn't really mattter if governement cuts reimbursement.

Derm is not all cash, by any stretch of the imagination. The field is absolutely susceptible to declining reimbursements as mandated by the Government. If you don't believe me, you may want to review some posts in the Derm forums.

In addition, there is more than enough competition in Dermatology (and basically every other specialty) in major metro areas that cash-only practices are not going to do well. This is true in most cases, though various local markets may have some exceptionally popular Physicians who can survive with cash-only. You maybe able to practice cash-only in some smaller markets (or if you're the Big Kahuna in a larger market), but the Derm shortage is not that severe. Plus, much of the cash-based work (i.e. Cosmetics) is cyclical in nature. The volume of cosmetic work goes down in weak economic cycle. Why would you pay a couple hundred for routine Derm care when your insurance could cover most of it?

Derm is a great field for a work/personal life balance and the income generated is great relative to the hours worked and relative lack of responsibility once you're done for the day. Just don't think this can't change.

Wall Street was a much better place to be working a few years ago than it is now.

abcabc1 said:

Derm is not all cash, by any stretch of the imagination. The field is absolutely susceptible to declining reimbursements as mandated by the Government. If you don't believe me, you may want to review some posts in the Derm forums.

In addition, there is more than enough competition in Dermatology (and basically every other specialty) in major metro areas that cash-only practices are not going to do well. This is true in most cases, though various local markets may have some exceptionally popular Physicians who can survive with cash-only. You maybe able to practice cash-only in some smaller markets (or if you're the Big Kahuna in a larger market), but the Derm shortage is not that severe. Plus, much of the cash-based work (i.e. Cosmetics) is cyclical in nature. The volume of cosmetic work goes down in weak economic cycle. Why would you pay a couple hundred for routine Derm care when your insurance could cover most of it?

Derm is a great field for a work/personal life balance and the income generated is great relative to the hours worked and relative lack of responsibility once you're done for the day. Just don't think this can't change.

Wall Street was a much better place to be working a few years ago than it is now.

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I agree derm is not the end-all-be-all that everyone says it is.

But it is one of the best positioned fields out there in medicine. If derm gets hit hard, I think the rest of the industry is looking at equally sweeping and depressing changes.

There's a reason why the cream of the crop of American medical schools routinely make derm, plastics, and ENT the most competitive residencies to get into.

abcabc1 said:

Derm is not all cash, by any stretch of the imagination. The field is absolutely susceptible to declining reimbursements as mandated by the Government. If you don't believe me, you may want to review some posts in the Derm forums.

In addition, there is more than enough competition in Dermatology (and basically every other specialty) in major metro areas that cash-only practices are not going to do well. This is true in most cases, though various local markets may have some exceptionally popular Physicians who can survive with cash-only. You maybe able to practice cash-only in some smaller markets (or if you're the Big Kahuna in a larger market), but the Derm shortage is not that severe. Plus, much of the cash-based work (i.e. Cosmetics) is cyclical in nature. The volume of cosmetic work goes down in weak economic cycle. Why would you pay a couple hundred for routine Derm care when your insurance could cover most of it?

Derm is a great field for a work/personal life balance and the income generated is great relative to the hours worked and relative lack of responsibility once you're done for the day. Just don't think this can't change.

Wall Street was a much better place to be working a few years ago than it is now.

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id disagree with this. derm and plastics are the best positioned specialties because they are cosmetic, cash oriented businesses, and even in economic downturns there will always be people with enough money wanting to look better. as an example, guess which segment of the housing market has not been affected by dropping prices. the ultra high end market. it's actually gaining. i'd love to see evidence that cosmetic procedures really go down all that much in a down market--i'd wager that they don't go down much. Certainly not enough to hurt these guys, especially with the huge need there is for them.

my guesstimation is that over the next 15 years, rads salaries will derease by some 20-30% before stabalizing. if tort reform begins to happen on a national scale then effective take home salaries will remain the same since malpractice is such a big part of expenses.

A large portion of any Physician's revenues and income (assuming they accept Medicare and Medicaid) is government controlled. Private insurance companies tend to follow suit (direction wise), while still paying more than Government. Can't we sue private insurance companies for doing that? It sounds unethical to me. They keep raking in more and more profits, so I don't see why they have to cut reimbursement when the government does so. Obviously the government is cutting because it wastes money on other crap and is broke, plus the increasing number of people who are enrolling in medicare is breaking the gov bank. But Private insurance companies are charging higher premiums than ever before. What gives? We should be able to sue them.

radslooking said:

id disagree with this. derm and plastics are the best positioned specialties because they are cosmetic, cash oriented businesses, and even in economic downturns there will always be people with enough money wanting to look better. as an example, guess which segment of the housing market has not been affected by dropping prices. the ultra high end market. it's actually gaining. i'd love to see evidence that cosmetic procedures really go down all that much in a down market--i'd wager that they don't go down much. Certainly not enough to hurt these guys, especially with the huge need there is for them.

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Cash based practices can be good and bad. In most cases, it's not feasible. I don't think very many Derm practices would survive taking cash only. The vast majority of Derm is medically-relevant management and treatment of conditions. You'll have some Derms specializing in cosmetics, but there is a need for medical Derm and that's what most Derms will focus on. You won't find people willing to pay cash for relatively routine care.

Plastic Surgery is not a specialty facing a severe shortage. Even the Merritt Hawkins site only has four listings for Plastics and the starting offers weren't all that.

NCY real estate is starting to soften as Wall Street gets hammered. It hasn't gone down as bad as the weak dollar has opened up opportunities for international buyers. Plus, most people on the ultra high end of real estate are a lot wealthier than the typical plastic surgery patient. A lot of people who get plastic surgery aren't that rich and their ability to spend is tied to the overall economy. Certain high end retailers and restaurants are feeling the pinch as well.

http://www.slate.com/id/2188419/

http://ny.therealdeal.com/articles/how-long-will-downturn-last-2

http://www.merritthawkins.com/job-s...ian&specialtyId=25&regionId=-1#jobGridResults

abcabc1 said:

NCY real estate is starting to soften as Wall Street gets hammered. [/url]

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It will come back

NYC real estate is doing quite well lemme tell you. i have a few friends looking for apts now.. studios for $2500-3400

ar2388 said:

NYC real estate is doing quite well lemme tell you. i have a few friends looking for apts now.. studios for $2500-3400

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How do residents afford to live there?

ar2388 said:

NYC real estate is doing quite well lemme tell you. i have a few friends looking for apts now.. studios for $2500-3400

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Reason #197 not to live in NYC.

IJL said:

How do residents afford to live there?

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Probably shares. I live in manhattan for my prelim year with a roommate in a modified 1 bedroom apartment ( with a very large bedroom where a queen doesn't quite take 1/4 of the room in a high rise building. I pay $1250/mo (sublet). I got lucky I found someone on craigslist needing a roomate.

It is probably the most economical way to live in nyc (assuming you want to live in manhattan).

The Manhattan programs I interviewed at provided subsidized housing, somewhere around $1500/month. The residents didn't really seem to emphasize saving money during residency, either.

some have housing and some dont. cornell and st lukes-roosevelt do. nyu doesnt.
and yea roommates are the way to go. you can sometimes find a studio for 1800-2000 but chances are it will be a walk up and/.or super tiny