Changing into radiology

[emergentmd]

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Guy,

I posted this on the radiology section and would like to know if anyone has changed fields, esp into radiology. I am not a troll, all my info is correct, and would be grateful for any information.

Please help me with my dilemma. I am 36 years old, finished an ED residency 7 years ago and have been working in a community ED in Texas.

I can't remember any of my USMLE scores but it was middle of the road, and I was in the middle of my class. I am not even sure if my stats matter as I have been working for such a long time.

I am getting somewhat burned out and am looking into a radiology residency. I have saved enough money, this is not a big matter for me.

Here is my dilemma. I am a partner and make alittle over 400k a year, working 15-16 days a month, 8 hr shifts. I can go down to part time any time I want. I would like to make as much or more if I finish a radiology residency. I know I would enjoy radiology as I got my electrical engineering degree in college and I enjoyed the math and physics. I think I can work longer and be happier as a radiologist.

Please help me with these questions.

1. Is it reasonable to expect to make 500+K coming out of residency. I hear that some of the radiologists at my hospital makes $1mil plus
2. How many hours are the radiologist working per day, how many days a month, and how many days on call?
3. How hard would it be for me to get into a residency at my age, and experience
4. How should I approach matching? Should I call up the program directors and ask if there is an opening? Should I go through the matching process?
5. Can I skip the intern year as I have done it already in my ER residency


Any thoughts, or advice would be helpful to me.

Again, Thank you

 

[Apollyon]

1. Is it reasonable to expect to make 500+K coming out of residency. I hear that some of the radiologists at my hospital makes $1mil plus

Folks turning $1mil/year are partners. Expect to start out $300/400K until you make partner.

 

[emergiQ]

Guy,

I posted this on the radiology section and would like to know if anyone has changed fields, esp into radiology. I am not a troll, all my info is correct, and would be grateful for any information.

Please help me with my dilemma. I am 36 years old, finished an ED residency 7 years ago and have been working in a community ED in Texas.

I can't remember any of my USMLE scores but it was middle of the road, and I was in the middle of my class. I am not even sure if my stats matter as I have been working for such a long time.

I am getting somewhat burned out and am looking into a radiology residency. I have saved enough money, this is not a big matter for me.

Here is my dilemma. I am a partner and make alittle over 400k a year, working 15-16 days a month, 8 hr shifts. I can go down to part time any time I want. I would like to make as much or more if I finish a radiology residency. I know I would enjoy radiology as I got my electrical engineering degree in college and I enjoyed the math and physics. I think I can work longer and be happier as a radiologist.

Please help me with these questions.

1. Is it reasonable to expect to make 500+K coming out of residency. I hear that some of the radiologists at my hospital makes $1mil plus
2. How many hours are the radiologist working per day, how many days a month, and how many days on call?
3. How hard would it be for me to get into a residency at my age, and experience
4. How should I approach matching? Should I call up the program directors and ask if there is an opening? Should I go through the matching process?
5. Can I skip the intern year as I have done it already in my ER residency


Any thoughts, or advice would be helpful to me.

Again, Thank you

I can't imagine someone residency trained as recently as 7 years ago not knowing the answers or having the contacts to get legitimate answers to some of these questions (or having some of these questions in the first instance).

I'm calling sull bhit.

 

[Toohotinvegas33]

I hope I never see the day where 400k is not enough.

 

[emergentmd]

I am sorry to offend someone with this post, as this was not my intention.

Do I have contacts to answer some of these questions? Absolutely.

Do I know of any radiologists personally from residency, no.

Being a partner is tricky, as it would not go over well with my other partners if they know I am seriously considering doing this. The medical community is such that even if I talk to some of the radiologists I know, I would be in a tough position if it ever leaks out.

I stumbled over this site and thought it had great answers, so I wanted to post anonymously to get some answers.

I am still considering the switch, and would like to leave my options open if I decided to not to go back to residency.

I know I have a great job, great pay, great hours and do not want to risk it if this leaks out.

Again, I did not post this to be judged. I realize I do well in the EM field, make more than most.

 

[southerndoc]

Folks turning $1mil/year are partners. Expect to start out $300/400K until you make partner.

Expect to make $150k/yr by the time you finish residency.

Say hello to "universal healthcare," aka socialized medicine. It's likely to happen whether we agree with it or not.

On another note, the CMS regulations clearly state that radiology exams can only be billed if it affects treatment. Therefore, an ordering physician and (and should) bill for the x-ray unless radiology is providing timely readings that affect treatment/diagnosis. An 11am read on the prior night's 8pm x-ray is not timely, and therefore, the ordering physician can bill for this and will be the only one reimbursed except under unusual circumstances.

 

[Egon]

You would not be applying for a PGY-1 spot, you would just do the 4 yrs of rads. The people making the mil are usually fellowship trained, which means 5 more yrs training, even if it means neuro, US, body, IR, etc. (The guys I know make 400-600K.)

Also, realize that you'll be losing 350Kx5= 1.75 million

Then you start from the bottom again making you current salary and move up to partner. In the long run you'll make back the money lost and then some, but for the next 5 years while you still have some youth you'll have a decrease in lifestyle.

Radiology is usually 9-5, especially now with nighthawk. Prepare for life in front of a computer.

There is very little that could make one want to go back an do residency again. You may have a better time with an MBA or a law degree if you are unhappy in EM, using your skillset to build into another career. Rads is going to be reading study after study as fast as possible. The people I know doing it like it, but it comes down to productivity and they also burn out from the number of studies...

 

[Jeff698]

On another note, the CMS regulations clearly state that radiology exams can only be billed if it affects treatment. Therefore, an ordering physician and (and should) bill for the x-ray unless radiology is providing timely readings that affect treatment/diagnosis. An 11am read on the prior night's 8pm x-ray is not timely, and therefore, the ordering physician can bill for this and will be the only one reimbursed except under unusual circumstances.

Not to threadjack this (actually, I an probably blame that on Southern) but how is it considered a timely reading that affects treatment when it takes two hours to read a film and we made the read, diagnosis and treatment 1 1/2 hours before it was read?

Take care,
Jeff

 

[southerndoc]

Not to threadjack this (actually, I an probably blame that on Southern) but how is it considered a timely reading that affects treatment when it takes two hours to read a film and we made the read, diagnosis and treatment 1 1/2 hours before it was read?

Take care,
Jeff

I agree, and some EM groups are now pushing that ALL reads be billed by the emergency physician. It is the emergency physician -- not the radiologist -- that will be held liable for an inappropriate read for a plain film x-ray that causes inappropriate treatment of the patient. If the radiologist reads the film four hours later and sends the report to the medical director the following morning, by then the patient could have suffered serious injury or even death if a significant finding was misread.

It's time we all took a stand and start getting reimbursed for the risks we take with reading plain films and EKG's. Unless radiology or cardiology is providing timely reads that affect patient treatment, then they have no right to be reimbursed for it. I agree that overreads are a great things to have to find missed subtleties (or sometimes even the obvious), but there needs to be another form of reimbursement for the radiologist for their overreads.

 

[roja]

Instead of residency training, perhaps you should consider finding other areas of EM that are nonclinical that will alleviate your burn out. There are many ways to do this.

 

[leviathan]

Expect to make $150k/yr by the time you finish residency.

Say hello to "universal healthcare," aka socialized medicine. It's likely to happen whether we agree with it or not.

Why do people always say this? Do you think Canadian radiologists only make $150k/year? Or do you think the US situation will be different from ours?

 

[southerndoc]

Why do people always say this? Do you think Canadian radiologists only make $150k/year? Or do you think the US situation will be different from ours?

I'm basing it on realistic expectations as evident by current Medicare reimbursements. Medicare will likely be the basis for any government operated single payer system.

 

[leviathan]

I'm basing it on realistic expectations as evident by current Medicare reimbursements. Medicare will likely be the basis for any government operated single payer system.

Fair enough...I just know that I hear it all the time, yet friends of mine even in family medicine are making more than 150k after overhead. A guy I know doing gas expects to make about 400k after residency, based on his pay doing moonlighting as a PGY-4. I don't think things are that much greener in the US for compensation. I think where you will see the biggest hit would be in your income taxes, rather than your gross salary.

 

[southerndoc]

Fair enough...I just know that I hear it all the time, yet friends of mine even in family medicine are making more than 150k after overhead. A guy I know doing gas expects to make about 400k after residency, based on his pay doing moonlighting as a PGY-4. I don't think things are that much greener in the US for compensation. I think where you will see the biggest hit would be in your income taxes, rather than your gross salary.

Yep, I would imagine we would pay an additional 15% tax to pay for a socialized health system.

$150k for an FP? I don't think our FP's make that much.

 

[leviathan]

Yep, I would imagine we would pay an additional 15% tax to pay for a socialized health system.

$150k for an FP? I don't think our FP's make that much.

Yeah the average is lower because a lot of FPs only work part-time, but if you are doing full-time hours you can easily make that much. I work for a company that advertises clinics for locum positions, and the more desperate clinics in urban areas are offering $150/hour minimum for family physicians to take shifts.

 

[The White Coat Investor]

1. Is it reasonable to expect to make 500+K coming out of residency. I hear that some of the radiologists at my hospital makes $1mil plus
2. How many hours are the radiologist working per day, how many days a month, and how many days on call?
3. How hard would it be for me to get into a residency at my age, and experience
4. How should I approach matching? Should I call up the program directors and ask if there is an opening? Should I go through the matching process?
5. Can I skip the intern year as I have done it already in my ER residency

1) No. I think that's a little high. I assume those making the big bucks do an interventional fellowship as well. Interventional=more call, more risk etc.

2) 6-10, ~20, varies highly. Mine is on call for 30/month but rarely gets called in.

3) Not hard if it is what you really want and you're willing to apply all over the place.

4) I'd just go through the match, bearing in mind that you might have to fund your own residency due to medicare rules.

5) Yes.

Why not try posting this over at the radiology forum? I bet their salary info would be more accurate than ours. But I don't know that radiology has an annual survey of salaries and working hours like EM has.

400K? Where are you, West Texas? If you're burning out why don't you cut back to half time and do some traveling or take up a hobby. It's pretty hard to burn out at 8 shifts a month.

 

[emergentmd]

1) No. I think that's a little high. I assume those making the big bucks do an interventional fellowship as well. Interventional=more call, more risk etc.

2) 6-10, ~20, varies highly. Mine is on call for 30/month but rarely gets called in.

3) Not hard if it is what you really want and you're willing to apply all over the place.

4) I'd just go through the match, bearing in mind that you might have to fund your own residency due to medicare rules.

5) Yes.

Why not try posting this over at the radiology forum? I bet their salary info would be more accurate than ours. But I don't know that radiology has an annual survey of salaries and working hours like EM has.

400K? Where are you, West Texas? If you're burning out why don't you cut back to half time and do some traveling or take up a hobby. It's pretty hard to burn out at 8 shifts a month.

Thanks for your input. I have already posted this, but they also called me a troll and there has not been alot of info, yet.

I am a partner, so I make made over 400k last year and probably will make closer to 450k this year.

I have been going back and forth about this decision.

If I stuck with ER, there are no risks. I could work 8 days a month and still pull in 300k a year as my partnership $$$ is close to being fixed. I do still like my job, but I guess with any job, issues that appear small to begin with gets tiresome.

If I went into radiology, I would be taking alot risks. I would lose out on 5 yrs of income as I would definitely go into interventional (I love procedures). That would costs me 5x450 = 2.25 Mil, or 1.5mil after taxes. I would be working alot of hours for 5 yrs rather than my 15 days a month. I can't be guaranteed that payment will still be high when I get out of residency. I would not be able to enjoy the rests of my 30's. There is alot of opportunity costs in this decision.

Radiology would allow me to work until I am older, and make more when I get out I suspect.

But if I stuck to ER, hopefully in 5-10 yrs, if I save enough (I have over a mil in the bank right now and have no real debt), I could have 3-5 Mil if the market doesn't crash. At that time, I could cut back to 6 shifts a month and still do fine.

Working 6 days a month would not burn me out.

I keep going back and forth with this decision. I still have a few months to decide.

Oh, I work in one of the 4 major cities in Texas and people I know would die to have the job I have.

 

[EM_Rebuilder]

Thanks for your input. I have already posted this, but they also called me a troll and there has not been alot of info, yet.

I am a partner, so I make made over 400k last year and probably will make closer to 450k this year.

I have been going back and forth about this decision.

If I stuck with ER, there are no risks. I could work 8 days a month and still pull in 300k a year as my partnership $$$ is close to being fixed. I do still like my job, but I guess with any job, issues that appear small to begin with gets tiresome.

If I went into radiology, I would be taking alot risks. I would lose out on 5 yrs of income as I would definitely go into interventional (I love procedures). That would costs me 5x450 = 2.25 Mil, or 1.5mil after taxes. I would be working alot of hours for 5 yrs rather than my 15 days a month. I can't be guaranteed that payment will still be high when I get out of residency. I would not be able to enjoy the rests of my 30's. There is alot of opportunity costs in this decision.

Radiology would allow me to work until I am older, and make more when I get out I suspect.

But if I stuck to ER, hopefully in 5-10 yrs, if I save enough (I have over a mil in the bank right now and have no real debt), I could have 3-5 Mil if the market doesn't crash. At that time, I could cut back to 6 shifts a month and still do fine.

Working 6 days a month would not burn me out.

I keep going back and forth with this decision. I still have a few months to decide.

Oh, I work in one of the 4 major cities in Texas and people I know would die to have the job I have.

Hold out three more years, then rec me to be step right into your place as a Texan myself. I dunno if its Houston, Dallas, Austin, or ?....who really is number four in Texas... Ft Worth, San Antonio, El Paso...

Anyways, I always think it sucks to hear a BC EM physician talking about actually being burned out, but like with any field, I guess it does happen...

If I was in your shoes, I do not quite understand why you just do not begin to pull back now as far as number of shifts. Money is not everything, I assume you figured that out by now, and 1-5 shifts per month, plus bank interest in a million (kudos if you can invest and beat bank interest) certainly is not a bad income and continues to create much wealth for your family...

 

[emergentmd]

Hold out three more years, then rec me to be step right into your place as a Texan myself. I dunno if its Houston, Dallas, Austin, or ?....who really is number four in Texas... Ft Worth, San Antonio, El Paso...

Anyways, I always think it sucks to hear a BC EM physician talking about actually being burned out, but like with any field, I guess it does happen...

If I was in your shoes, I do not quite understand why you just do not begin to pull back now as far as number of shifts. Money is not everything, I assume you figured that out by now, and 1-5 shifts per month, plus bank interest in a million (kudos if you can invest and beat bank interest) certainly is not a bad income and continues to create much wealth for your family...

Like I have said, I think I have one of the best job in the EM field. It is definitely not the job.

After leaving residency, I was expecting to make $200k and if I made 250K, I would be ecstatic. When I first start, I made more than this and Loved everything. I could think of 99% of other medical fields that I would never go into now that I see what they do.

ER is uncomplicated IMO. When I am done, i am done.

When I was finished with medical school, I was down to radiology and ER. I picked ER. I guess I have always thought if this was a mistake.

I am sure if I picked Radiology, I would have issues with that too. I am not sure I could sit in a dark room for hrs at a time.

I guess sometimes that the grass may not be greener on the other side

 

[Strength&Speed]

Maybe you are just looking for something new and stimulating. If that's the case, go try it. You stil will be making close to 50,000 x 5 yrs. Thats not a ton, but its something, and you'll be accruing interest on your money saved. And you can quit your rads residency if you don't like it. However, the big risk is if you don't like rads and try to get back into EM you wont' have the sweet gig anymore. But hell, you only live once. You have enough money already, do what you want.

 

[domer621]

I do still like my job, but I guess with any job, issues that appear small to begin with gets tiresome.

I know this isn't going to help your decision, but can you expound on this, please? I'm interested in what could be so tiresome that it would cause you to be burned out after 7 years working.


Also, for what it's worth, most of the new rads graduates I know have initial offers of $300k per year.

 

[Strength&Speed]

I know this isn't going to help your decision, but can you expound on this, please? I'm interested in what could be so tiresome that it would cause you to be burned out after 7 years working.


Also, for what it's worth, most of the new rads graduates I know have initial offers of $300k per year.

right. I think you will be disappointed if you are expecting to make 500K guaranteed in rads. yes, chances are higher in interventional than others, and I would personally bet you could make 500 after you graduate, but expecting to would be a huge mistake. Do rads for rads, but do it only if you can handle getting paid less than you do now, in case thats the way things go.

as an anecdote, i have a friend (non fellowship trained) who is making 375k 7 on 7 off, at 10 or 12 hrs a day. that's telerads, but that's also humping out studies. And although he desired flexibility, i think he looked at the most lucrative deals as well.

 

[emergentmd]

It looks like I probably won't be much ahead $$$ wise if I go back for radiology.

The biggest concern I have with medicine is reimbursement. There is no way our system can function with the cost of medicine as it is. I am sure it will go down, so it might be better to make as much as I can now, and then cut back when the golden goose is not as good.

A patient I saw for a kidney stone yesterday with a CT renal protocol, U/A, CBC, Chem 7 was billed for 7K+.

I don't see how medicine can continue with reimbursement when charges are so high.

 

[Toohotinvegas33]

Thanks for your input. I have already posted this, but they also called me a troll and there has not been alot of info, yet.

I am a partner, so I make made over 400k last year and probably will make closer to 450k this year.

I have been going back and forth about this decision.

If I stuck with ER, there are no risks. I could work 8 days a month and still pull in 300k a year as my partnership $$$ is close to being fixed. I do still like my job, but I guess with any job, issues that appear small to begin with gets tiresome.

If I went into radiology, I would be taking alot risks. I would lose out on 5 yrs of income as I would definitely go into interventional (I love procedures). That would costs me 5x450 = 2.25 Mil, or 1.5mil after taxes. I would be working alot of hours for 5 yrs rather than my 15 days a month. I can't be guaranteed that payment will still be high when I get out of residency. I would not be able to enjoy the rests of my 30's. There is alot of opportunity costs in this decision.

Radiology would allow me to work until I am older, and make more when I get out I suspect.

But if I stuck to ER, hopefully in 5-10 yrs, if I save enough (I have over a mil in the bank right now and have no real debt), I could have 3-5 Mil if the market doesn't crash. At that time, I could cut back to 6 shifts a month and still do fine.

Working 6 days a month would not burn me out.

I keep going back and forth with this decision. I still have a few months to decide.

Oh, I work in one of the 4 major cities in Texas and people I know would die to have the job I have.

Why did you go into medicine? If making 400-450k a year isnt motivation enough to get a$$ out of bed in the morning to work more then 8 shifts a month, I really doubt you want to go thru 5 more years of residency.

 

[Aloha Kid]

Seems like you've received more questions than actual answers.

I think the simple fact is YES, you can do it. YES a switch is possible.

You face a number of issues. The biggest issue is ignorance. A physician who wishes to switch specialties is often seen as weak. Some younger physicians may perceive your attempts as a threat and encroachment on their territory. Friends and co-worker may feel devalued as a trusted co-worker now has forsaken the specialty. They have relied upon your motivation and example for years and now you get up and leave them as though EM is not good enough anymore. Many will question your maturity level & ability to cope.

We are humans! Our interests, values, and needs change. We are forced when we are relatively young and naive to make career choices that wrongfully bind and lock us in the rest of our lives. No one can read which way a trail will turn miles down the road. Just look at the number of marriages ending in divorce. Even the most thoughtful and committed decisions early on can fail. There comes a decision point. We can hold tight and stick to it, or we can change. Far too many of us hold on and stick to it probably needlessly. Medicine should foster an environment allowing change and career development. We need more people like you to change medicine for the better. You will be an outstanding Radiologist with sympathy and a keen eye for all Emergency cases. You will have experience and expertise that will better both fields.

Obstacles you face are biased program directors and co-workers, funding issues (government pays less for a grad who has already used their alloted years), accreditation, personal sacrifice, and most importantly family sacrifice. You may need to be willing to move to a program anywhere in the U.S. as choices may be limited. You will have to compete with young graduating residents for highly competitive spots. Most of all you face a culture that does not foster change.

Good luck to you. Your best bet is to begin calling various program directors early on before interview season to gauge the possibilities.

Carol Rivers has a CD you can buy that talks about career development called "Designing a career in Emergency Medicine" it may be insightful as it does not just relate to staying in the field of EM. There is another CD called Lets Talk Turkey w/ Edwin Leap. They talk about the culture of silence in EM re: many of the stressors we face. Here is the website. I suggest purchasing the CD as the MP3 file is kind of iffy.

https://emeeinc.com/

 

[bartleby]

Think about what going back to residency (q3-4 call) from a relatively comfortable attending lifestyle with a 95%th percentile salary for EM is going to do you in regard to burnout and fatigue in your career before things get any better. Are you looking for a change of pace or are you looking for a lifestyle change. If it is the latter, you are better off investigating administrative possibilities or other non-clinical avenues.

 

[GeneralVeers]

I don't see how medicine can continue with reimbursement when charges are so high.

That does not seem like a rationale to quit and change jobs, more like a socioeconomic theory.

There will always be Emergency Departments, and hospitals will always need physicians to staff them. Your salary may vary +/- a few $$$, but you can be sure of job security.

At least EM jobs can't be exported to India like some other "nameless" specialties.....