OldRad

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After reading through a few of these threads, let's think about the downside:

Why NOT to go into radiology:

-Sitting in a dark room all day: A fair number really do get depressed by it.
-Studying: If you enjoyed third year of med school much much more than second year, that might be a warning sign. Imagine doing a solid two hours of rad textbook reading every night, after burningyour eyes out from a full day of work and learning in residency. Add a good several hours of reading over the weekend and post-call as well.

If you inherently enjoy the field, and if you have a bit of the scholar in you, the books and the journals won't be too painful. If you're just in it for the money (ha!) and easy lifestyle (ha! ha!), this will really become a chore. Either you won't study and your career and confidence will suffer, or you'll only reluctantly study, and you'll start to think, "maybe I should switch into X."

-Physics Board Exam: this is Part One of the American Board of Radiology Exam, taken when you're about half-way through your rad residency. Failure rate is nearly 20%. You'll face the oral and written boards a couple years later.
-Lifestyle: sure, it's not as bad as transplant surgery, but you'll work harder and have a lot more stress than you probably imagine. You're on call; it's the middle of the night: tell me doc, do we operate or not? And guess what? That one thing you missed last June? Yeah, it was cancer, and your lawyer wants a call back ASAP. What? You haven't been keeping up, staying sharp? Tell it to the jury.-Uncertain future of the field: the out-sourcing threat often gets overblown, but rads is a young field, so no one really knows what might happen over the next 5 to 10 to 20 years. Along with out-sourcing, there's turf wars (Cards and Neuro already. More generally, why should they refer to rads if they can create a one-year fellowship and keep the work to themselves?) and declining reimbursements (already a reality). Meanwhile, molecular imaging could revolutionize everything, but do you really need to pay a radiologist $100 per image to say, "yes, it lights up" or "no, it does not"??
-Minimal patient contact (dx rads more than IR): you have to decide if this is a good or bad thing, and it's tricky in med school. It's tough to say if you didn't like the entire field or if you just didn't like being the rookie in that field. You won't like being a rookie in rads either. Plus, many physicians report that they enjoy patient contact more and more as their own skills develop and as they advance in their fields. Similar thing for surgery: once you get some real hands on experience and you start to get some practical power, you might see what all the fuss is about.

-Lack of respect: you'll get this from some colleagues, from some patients, and from plenty of folk at the cocktail parties ("What, so you do X-rays??"). In the end, you should feel proud to do what you do.
-The money and lifestyle myth: as with many fields, the best jobs in terms of lifestyle OR money are often in the least popular regions of the country. And yes, I can almost guarantee that you won't have mad money and an easy lifestyle (barring any lottery-ticket-type good fortune).
Also, you really can do well for yourself in any field of medicine. There's a big bell curve out there in terms of money and lifestyle for each and every field. Family med docs making $500,000? Sure thing. Rehab docs making even more? Think pain management. Docs with an entrepreneurial bent? Sky's the limit. Radiologists hanging on for an early retirement because they just don't enjoy their work? That happens as well.
Another thing about the money: we all say, "don't choose based on money." It's not because money's unimportant. It's because -- when you're at the attending level in any field -- you'll have some control over how much you make. You can work more, become more efficient, hire a great business manager, do some pharm / industry work on the side, etc. etc. The other big thing is this: once you've got some savings in the bank, which will come soon enough, then an extra $100K per year won't be worth it -- not at all, not if you don't enjoy the thing you do for 50+ hours per week.
 

hans19

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Valid points, but a bit dramatic from a new member, 'old' rad.
 

poloace

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yeah, that message by old rad is about the most **** thing i've read in a while. thanks for your wisdom, scrote!
 
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f_w

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-Sitting in a dark room all day: A fair number really do get depressed by it.

The majority treasure it.

-Studying: If you enjoyed third year of med school much much more than second year, that might be a warning sign. Imagine doing a solid two hours of rad textbook reading every night, after burningyour eyes out from a full day of work and learning in residency. Add a good several hours of reading over the weekend and post-call as well.
Sure, if you are knowledge averse and like to write your notes in crayon, you are probably better off in a different field.

-Physics Board Exam: this is Part One of the American Board of Radiology Exam, taken when you're about half-way through your rad residency. Failure rate is nearly 20%.

Pass rate on the second try is close to 100%.

You'll face the oral and written boards a couple years later.

And that is different to any other medical specialty how ?

You're on call; it's the middle of the night: tell me doc, do we operate or not?

I leave the middle of the night stuff to our nighthawk company.

so no one really knows what might happen over the next 5 to 10 to 20 years.

Giant ants will descend on us, black helicopters and Barack Obama will steal your hard earned money right from your pocket.


but do you really need to pay a radiologist $100 per image to say, "yes, it lights up" or "no, it does not"??

Ahem, yes. (In most of the nucs study I get the $100 purely for taking responsibility for a study not for the outstanding intellectual work I provide)

Plus, many physicians report that they enjoy patient contact more and more as their own skills develop and as they advance in their fields.

Others realize that patient contact is not all it is hyped up to be the further along they advance in their fields. They sit in my reading room, let out a sigh and say 'I should have gone into rads back when I had a chance'.

-Lack of respect: you'll get this from some colleagues, from some patients, and from plenty of folk at the cocktail parties

If your self esteem is based on this type of outside reinforcement, maybe you are better off as a brain-surgeon or rocket scientist.

-The money and lifestyle myth: as with many fields, the best jobs in terms of lifestyle OR money are often in the least popular regions of the country. And yes, I can almost guarantee that you won't have mad money and an easy lifestyle (barring any lottery-ticket-type good fortune).

I work 9-5 and have a comfortable income, can't complain here.
 

nutcancer

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this whole don't do it for the money if you don't love it is complete BS in my opinion. i think as an intellectual, you can learn to love anything as long as there's beauty in it. this is why i find that above advice to be trite and useless. these miserable radiologists you speak of, must have an imbalance outside of their professional lives as well.

lets face it people. every damn job gets old, every single one. how much fun is it really when you're doing your 1000 coronary stent? how much fun is it too put in implants for the 12,000 time? how much fun is it to treat a cough for the gazillionth time as a GP? how much fun is that 500th knee replacement? the only 'fun' jobs are the really badass acute critical care/trauma surgery where there's an adrenaline rush in every case.

its just a damn job. why not choose something that is the relative easiest, least busiest, and best pay/hour field?

god, u guys have no idea how many private practice radiology reps i've seen in my community medicine rotation and how they all tell me to go into rads. one has to be crazy not to consider it.
 

ObGyn

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i can tell you this, if barack obama or hiliary change it to a universal system, rads will get a harder hit. all eyes have been on rads for many years because of the high billing and compensation.

i am definitely worried because i am just getting into the field. i certainly wish this were true though

in retrospect, i really should have gone into ophthal or oculoplastics or plastics surgery because elective procedures are out of pocket and will take the least hit from a socialized medicine

The majority treasure it.


Sure, if you are knowledge averse and like to write your notes in crayon, you are probably better off in a different field.



Pass rate on the second try is close to 100%.



And that is different to any other medical specialty how ?



I leave the middle of the night stuff to our nighthawk company.



Giant ants will descend on us, black helicopters and Barack Obama will steal your hard earned money right from your pocket.




Ahem, yes. (In most of the nucs study I get the $100 purely for taking responsibility for a study not for the outstanding intellectual work I provide)



Others realize that patient contact is not all it is hyped up to be the further along they advance in their fields. They sit in my reading room, let out a sigh and say 'I should have gone into rads back when I had a chance'.



If your self esteem is based on this type of outside reinforcement, maybe you are better off as a brain-surgeon or rocket scientist.



I work 9-5 and have a comfortable income, can't complain here.
 

cdql

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i can tell you this, if barack obama or hiliary change it to a universal system, rads will get a harder hit. all eyes have been on rads for many years because of the high billing and compensation.

i am definitely worried because i am just getting into the field. i certainly wish this were true though

in retrospect, i really should have gone into ophthal or oculoplastics or plastics surgery because elective procedures are out of pocket and will take the least hit from a socialized medicine

Hmm...it would take more than $500K/yr for me to work 9-to-9 doing boob jobs all day long.
 

f_w

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i can tell you this, if barack obama or hiliary change it to a universal system, rads will get a harder hit. all eyes have been on rads for many years because of the high billing and compensation.

Actually all eyes are on clinician self-referred in-house imaging. This is where the growth in imaging expenses really lies.

in retrospect, i really should have gone into ophthal or oculoplastics

LoL, you might want to talk to a couple of ophthos before you make a change for that reason.

or plastics surgery because elective procedures are out of pocket and will take the least hit from a socialized medicine

Elective procedures will take a hit if the economy takes a dive and some of the 'froth' that can be spent on boob-jobs has to go into retirement planning.

There are plenty of plastic surgeons running around who do lots of breast-cancer work, not because of their altruistic vein showing through but rather to pay the bills. Don't mistake Dr 90210 for reality.
 

cdql

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There are plenty of plastic surgeons running around who do lots of breast-cancer work, not because of their altruistic vein showing through but rather to pay the bills. Don't mistake Dr 90210 for reality.

Very true. Getting established in plastics is an arduous task. With the promise of money often coming much later than what we see plastered all over the Dr. 90210 show!
 

R-Me-Doc

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Actually all eyes are on clinician self-referred in-house imaging. This is where the growth in imaging expenses really lies.


OK, I'm gonna demonstrate my ignorance here. Please don't flame me, cause I've never really been able to figure this out, probably since I have never worked in private practice, just academic and military med. What exactly is "clinician self-referred in-house imaging" and why is it a "no-no"?

I'm guessing that it means you can't send patients to get studies at facilities you own or have a stake in, right? I understand the alleged "financial/ethical conflict of of interest" regarding ordering unnecessary tests just to rake in the bucks, but really, don't hospitals do that all the time? I mean, no hospital practice (either inpatient or outpatient) purposely tells patients that they have to go to a completely unaffiliated lab or rads facility to get tests done; they just go to the hospital's testing facilities (even if it was an outpatient visit -- obviously you're not going to ship an inpatient somewhere else for a study). You just tell the patient "go to the lab/x-ray dept to get a test/x-ray" and the patient goes to the in-house lab; they don't flip through the yellow pages to find somewhere else, right? So how is this different from me operating my own freestanding clinic that happens to have an x-ray or CT or MRI, and I do my own pictures? :confused: :confused: :confused: Am I actually supposed to tell every patient "you can get your films here, or you can go somewhere else?" Or am I just forbidden as a clinician from having any diagnostic imaging equipment because I might be tempted to self-refer?

And does this apply to other specialties and procedures? If you go to, say, a neurologist who thinks you need an EEG, are they techically supposed to tell you to go somewhere else to get it instead of just doing it themselves? If not, how is that different from imaging studies? Wow, this just drives me nuts. I can't wait til Hillary makes us all minimum wage slave drones so we don't have to worry about any of this any more :laugh:
Thanks for the explanation.
 

f_w

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I'm guessing that it means you can't send patients to get studies at facilities you own or have a stake in, right?

Actually, you are allowed to send patients to your own testing facilities if they are within your own office (in-office exemption). You are not allowed to send them to a freestanding facility that you own shares in. Bizarre, but this is the federal goverment for you.

I understand the alleged "financial/ethical conflict of of interest" regarding ordering unnecessary tests just to rake in the bucks, but really, don't hospitals do that all the time?
Hospitals for the most part get paid through DRGs, meaning they get the same money for your admission for a cholecystectomy whether your doc orders 1 ultrasound and 1 CBC or whether they get hourly blood-gasses.

So how is this different from me operating my own freestanding clinic that happens to have an x-ray or CT or MRI, and I do my own pictures?

The utilization of imaging goes through the roof the moment the referrer generates part of his income from the imaging he orders. It has also been shown that this additional imaging doesn't lead to improved outcomes.

Or am I just forbidden as a clinician from having any diagnostic imaging equipment because I might be tempted to self-refer?

You are not forbidden, but medicare (and particularly commercial insurers) are looking at ways of putting the brakes on it because it drives up their cost without measurable benefit.

If you go to, say, a neurologist who thinks you need an EEG, are they techically supposed to tell you to go somewhere else to get it instead of just doing it themselves?

Well, in the past people indeed went to the hospital to get the EEG and the neurrologist would either get a box with the tracings or a report from the neurologist the hospital contracted with. That way, the incentive to just get EEGs on everyone who presents with a headache to you (it could be a seizure equivalent, right) wasn't as big.
 
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