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Explain Radiology to me!

Discussion in 'Clinical Rotations' started by Mango, Aug 13, 2002.

  1. Mango

    Mango Very Senior Member
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    Cause I don't understand the draw. I'm not belittling anyone who is interested in rads, but I can honestly say that after only two days of it, I've never been so bored! I spent 6 hours straight in a dark room yesterday, watching an intern read bone films. Oh look, another fracture. Hey, is that a fracture? Wow, check out that fracture. Today was nuclear med which was more interesting for sure, but still, these guys sit around all day waiting for new bone scans or V/Q studies or thyroid scans, or whatever to come in. Then they read them, dictate, and go back to sitting and waiting for more pictures to look at. I asked the fellow why rads, and he answered: "I don't like patients!" Well, okay, makes sense.

    Call me crazy (you wouldn't be the first), but I don't care if you only work 30 hours a week and make $2 million a year, it's still not worth it! After a few years of that, I'd be up a belltower with a high-powered rifle gunning people down.

    Well, I guess that's one more specialty to cross of the "list." Sorry about the rant. Luckily rads is only 2 weeks, I think I'll live. Tomorrow's angio, that'll probably be cool...
     
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  3. Mango

    Mango Very Senior Member
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    Yeah, I deffinately can see your point. And you're right, it's not for everybody, and neither is IM (that's not for me either). But after spending today in the interventional radiology lab, rads seems much more interesting to me. I watched angio procedures all day, and it was cool as hell. I am deffinately cut out for a procedure based specialty, and that's what I saw radiologists doing today. So I will retract a few of my previous yawns (but not for bone x-rays, those are still boring in my opinion). And you are right, radiologists do get to play with the most fun high-tech toys.

    Tomorrow is ultra-sound, which should also be cool.
     
  4. xraydoc

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    It is definitely an individual thing in choosing a medical speciality. One thing that I can tell you is this: I have never (really) met a radiologist who said he didn't like his job. Many may complain about their colleagues, capitation, legal issues etc, but we like doing radiology.
     
  5. Winged Scapula

    Winged Scapula Cougariffic!
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    Yep...that's what they're getting these days. One of the interventional fellows here told me about a guy offered $800K with 6 (yep, count 'em...six) months of vacation and he turned it down for a better offer. $1 million is not unheard of either.

    Sounds pretty darn tempting to me. ;)
     
  6. ligado

    ligado Junior Member
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    mango,
    i feel for you...im doing a rad rotation this month in order to have an easy month - you know recovering from boards in july and preparing for surg in sept...but im so bored! i cant help but fall asleep in a dark room listening to the first year rad resident stutter thru dictations...i try to be positive and think about how valuable it will be to be able to somewhat read chest films but i cant possibly imagine anyone wanting to do this for 25+ years....id start shooting into crowds too! i think ill make my fortune in neurosurg - at least ill be doing something, anything!
     
  7. Arunski

    Arunski Member
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    What is a neuro-interventional fellowship? Is it a specialization in radiology or neurology?
     
  8. Jim Picotte

    Jim Picotte Senior Member
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    Neurointerventional is a subspecialization of radiology.
     
  9. Arunski

    Arunski Member
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    Haha, well I'm just curious to know what sort of options are out there...and the prospect of 800k a year sounds like something to keep an eye on.:laugh:
     
  10. jdog

    jdog Senior Member
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    That is such BS about 800K in 6 months. There ain't no hospital in this country that can afford to pay that for 6 months of work.

    Anyway, if you want to run with the big boys, you need to be banking at least 1 bar a year (million dollars) for the lightweights out there. If your friend wants to be a real player, he might want to extend his work year to 8 months.

    I have had it with the website and its heresay information.

    A guy off the side of the street can sign up on this website and say anything he wants.
     
  11. xraydoc

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    That is not BS friend. Check out this resource.

    http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

    These are the latest recruitment stats. Radiology is second behind plastic surgery in highest salary placed. Over 800k a year. I agree about the 6 months--I think that is somewhat apochryphal (I have heard that multiple times for the last few years, and doubt that it is true).

    I can tell you though that almost every day I get offers for jobs at 500-600 a year. That is no lie. It is amazing.
     
  12. Whisker Barrel Cortex

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    Although I agree that that 6 months vacation is probably a little bit of a stretch, I have heard of neurointerventional radiologists getting offers in the 800K-1mil range. I have also heard of general or non-interventional trained radiologists getting offers in the 300-500K range. Some of this is first hand knowledge, some not.

    As a prelim intern going into radiology, I can tell you that I have already received a recruitment letter from a group looking for new partners. I'm assuming they just sent it to everyone on the list of radiology residents, regardless of year. There is no salary listed. I do know that some 3rd year residents (2 years from finishing) are getting personalized offers from groups. Its high demand.

    As for the person saying that hospitals will not pay that much. Most radiologists are not hospital employees. They are groups of independent contractors who sign contracts with hospitals.
     
  13. Arunski

    Arunski Member
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    If salaries are this ridiculously high, would it be safe to assume that in 4 years when everybody realizes this, getting a radiology residency will be even more competitive than fields like dermatology?

    And is it just me, or does anyone else find it hard to grasp how one person's technical services can generate enough revenue to allow for an $800,000 salary. I know it's all about supply and demand, but is there really that great a demand for radiology services? What exactly are radiologists doing that bring in all this revenue? And who could possibly pay for those services if they are wildly expensive....sounds to me that HMO's would try and focus on cutting back this sort of stuff...Maybe it's just because i don't know much about the field, but can anyone enlighten me here?:confused:

    Also, all this information on radiology is making me question the path that i am planning on going down....I'll be graduating from undergrad soon, and was planning on doing an MD at St. Georges....but from the looks of it, IMG's don't have a very good chance of getting residencies in radiology....would you veterans think that going the DO route would be more wise if one wanted to have the option of doing radiology open?

    Thanks,
    Arun
     
  14. jdog

    jdog Senior Member
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    Congrats on the salaries boys. Very impressive.

    Maybe you can take some of that 800K and buy some humility.

    Damn, that is 400K in taxes. Ouch
     
  15. Mindy

    Mindy Senior Member
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    Perhaps talking to some clinical pathologists who lived through the medicaid crunch of the 80s is in order. My guess is that reform in radiology fee schedules is a matter of time.

    Mindy
     
  16. Whisker Barrel Cortex

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    Nothing but humility here. I realize that by the time I graduate residency, salaries will likely be less than they are now. Demand changes, as does reimbursement. Doesn't bother me much because I love the field and plan on entering academic practice, which doesn't pay nearly as well.

    Neurointerventional radiologists make these impressive salaries because the procedures they do are very expensive. They coil (close off) brain aneurysms that neurosurgeons can't reach surgically by going intra-arterially. They embolize brain tumors prior to surgery to prevent bleeding. Some deliver thrombolytics (clot busters) directly to stroke areas. They inject a form of cement into compression fractures of the vertebrae. All of these procedures are extremely dangerous, require a high degree of skill, and are very expensive. Most neurointerventional rads are on call quite often since there aren't that many of them per group. They work their butts off. They also train longer than almost any specialist. 1 year internship, 4 years radiology residency, 2 years neuroradiology fellowship, and 1-2 years neurointerventional. This adds up to 8-9 years of post med school training.. Equivalent to or more than neurosurgery.

    As for general rads, some of the reason for the good incomes coming out of residency is demand. The main reason for good incomes in general is the overwhelming volume of imaging studies that are ordered by clinicians. The volume of CT scans has been increasing at a breakneck pace as the machines get faster and clinicians (especially ER docs) get more careful and litigation-conscious.

    For those who choose rads just because of the income or lifestyle, it may be a disappointment. Lifestyle has been tougher lately, with many attendings being up much of the night reading CTs. Income is good now, but will likely decline as medicare decides to unilaterally decrease reimbursement and insurance companies follow.
     
  17. xraydoc

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    Polk I think is an idiot IMHO.

    Anybody who says reading a CT is easier than reading a CXR doesn't have a clue. First of all you can see nodules as small as 2mm on CT that cannot be seen on CXR. Studies show that a CXR can be accurately read in 30-60 seconds by an experienced radiologist. I read CTs faster than most and it takes me at least 10 minutes to read a relatively normal scan of the chest/abdomen/pelvis. MRIs take longer. We do virtual colonoscopy which have over 1000 images and take 15-20 minutes to read.

    Polk just seems to hate radiologists. I think that he was rejected by the radiology match and has never recovered.
     
  18. GuitarMan

    GuitarMan Guitarman for President
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    He glorifies while expressing pretty extreme resentment.
     
  19. ckent

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    To be honest, I still don't understand how physicians in some specialties manage to make so much money. I understand that there might be a shortage of radiologists around, but what's to stop insurance companies from deciding to lower the reimbursement fees that they will pay for all radiological studies? I was talking with a pediatrician, and he was telling me that he and other physicians were free to "charge" whatever they wanted, but insurance companies always had a set amount that they would reimburse physicians. And since insurance companies are much bigger then any physician practice and physicians can't unionize, the physician was always left just accepting whatever the insurance companies felt like paying them. So invariably, they always recovered ~50-60% of what they charged to insurance companies and they would just write the rest off at losses. Granted, this pediatrician worked with a lot of medicaid patients, but I don't see why the same principle wouldn't hold true for private insurers. What's to stop the same thing from happening to radiology or any field? If the CEO of Blue cross woke up one morning and decided to halve the amount that he wanted blue cross to reimburse radiologic studies, I don't see what anybody could do besides accept it.
     
  20. MacGyver

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    I agree with you ckent. These people supposedly making 500k+ a year are only going to get that salary for maybe a year before Medicare/Medicaid and the rest of the insurance world get wind of it and then salaries will fall back down to earth.

    So although i do think there are some exceptional people getting 800k offers, I would bet everything I have that in 2 years they will have dropped to 400k
     
  21. MD2b06

    MD2b06 Senior Member
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    They could choose to no longer accept the insurance. Believe it or not, there was a time when many physicians didn't accept Medicare because of inadequate reimbursements. Granted, that was during the golden days of medicine. My how things have changed......
     
  22. Mindy

    Mindy Senior Member
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    This is precisely what I was getting at when I mentioned the clinical pathology scene of the 1980s. (note: my previous post says medicaid...this is incorrect and should be read medicare).

    In short, when automation became prevalent in the pathology labs in the 60's and 70's, clinical pathologists were making unholy fortunes by charging the same or elevated prices for lab tests as the hand-done, pre-machine days. There was no regulation on the amount of money physicians charged for services--physicians charged a "fair" fee-for-service price and insurance companies reimbursed unquestioningly. Insurance companies in return charged employers more money for premiums, and employers wrote it off as deductibles. It was a circular, and economically wasteful process.

    So reform in the late 70s and early 80s attempted to curb financial waste with HCFA (health care financing administration) deciding to implement a fee schedule for medicare recipients (in all specialties not just pathology). In essence a bunch of suits sat around in a room and decided what doctor services were worth. This was without much rhyme or reason, but remains the basis of "coding" for health care billing to this day. Each diagnosis carries a set medicare fee and the difficulty of the service (1 = easy, 2 = medium, 3 =hard ... etc.) is assigned by the physician. For every bill submitted for reimbursement to medicare, HCFA pays the physician the amount of money on the medicare fee schedule. Not surprisingly, private insurance companies said, "well if this is all that the government is going to pay, this is all that we are going to pay too." This means that while doctors *can* charge whatever they want, they will only get paid what HCFA says they earned, unless they have a boutique-style practice.

    Back to pathology... so this reform meant markedly decreased prices for lab tests and clinical pathology salaries sunk like rocks. Labs fired many pathologists in the later 80s and 90s in order to preserve the large profits they were used to making. Only now is the field recovering.

    How does this relate to radiology? The government will catch up and squash these inflated salaries... its only a matter of time and a matter of decreasing the demand/price of imaging technology. I think the real question is how long will it take?

    Mindy
     
  23. xraydoc

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    I think that the 800 k salaries are inflated and are an abberation. That being said, one of the reasons that the salaries are going up is the insatiable demand for imaging services that continues unabated. This is especially true for MRI/CT with PET soon to be the next wave. The efficiency of the radilogy department has increased 2-3fold over the last 10 years. This makes it possible for a single radiologist to do as much work as about 1.5 radiologists at least in the past. Most larger departments are now filmless and paperless. This contributes to the median salaries being in the 400K range. With the efficiency just increasing, and the primary care doctors unwilling to restrain the test ordering, I feel comfortable that radiologist salaries will remain in the upper quartile for the next 20 years as they have been in the last 15.

    To say that these insurance companies can dictate prices is just false. There has been a great rebellion toward managed care. The penetration of managed care has decreased around here and will continue to decrease. Two major medical centers in Grand Rapids have just de-participated in blue cross because they are not paying a fair reimbursement. Blue Cross is losing money--the hospitals are not. People will change insurance companies, they will not drive 2 hours away to go to a participating hospital. We are seeing the pendulum swing the other way with doctors now dictating to insurance companies more than in the past. That is another reason for the elevated salaries.

    Another false impression is that hospitals are not going to pay 600k a year because they would not re-coup this money in full. The fact is they have no choice. The choice is to pay the going rate or go without a radiology department.
     
  24. MacGyver

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    xraydoc,

    if you are comparing radiologists to other specialties then yes i would agree with you about salary, I was just talking about absolute numbers, which will continue to decrease for all specialties.

    These days, no doctor can afford to just shun Medicare. Too much of the patient population uses it. The only way a doctor could not accept medicare/medicaid is if their practice is in a very exclusive rich neighborhood that can afford to pay out of pocket for their healthcare (or otherwise have very lucrative, boutique-style insurance plans). Obviously there are not that many places in America which have that kind of environment, so only a very tiny minority of doctors will ever enjoy that atmosphere.

    For the rest of us, Medicare/Medicaid and by extension all insurance companies WILL be dictating rates to us. You either follow their rate codes or you dont practice, its simple as that
     
  25. Diogenes

    Diogenes Succat
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    During one of my interviews last year the dean of admissions, who was interviewing me, was talking to me about Medicare reimbursements. He said that he knows many doctors who now do not see any medicare patients because the reimbursements are so low that these doctors literally lose money every time they see a patient -- the reimbursements don't cover the cost of seeing or treating the patient. So they would rather see no one than see a medicare patient. I really doubt this guy is making up stuff -- what purpose would that serve?
     
  26. droliver

    Moderator Emeritus 10+ Year Member

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    xraydoc,

    though I wish it were as easy as to tell the govt. or the insurance companies to shove it, the reality is they are in a much stronger negotiating position for these contracts almost all the time. The exceptions to these are fee for service practices (cosmetic plastic surgery, LASIK & other opthomology procedures, and a scattering of other super-specialists for whom people will pay out of pocket to see).

    I think radiology could be in an even weaker position than some other specialties for this with diagnostic hospital studies due to the expanding tele-radiology fields. You could imagine that if a radiologist or group of radiologists were refusing contracts, they (a hospital or insurer) could shop elsewhere, even across the country for a rock-bottom bid to have films read. They already do this in a sense for surgery contracts (although your competitiors are by neccessity local) by paying flat fees for surgery, regardless of the diffuculty of the procedure or the skill of the operator & if you don't like their offer, they find someone else for their clients.
    In some markets, large groups of surgeon have joined together for stronger collective bargining power with mixed success
     
  27. jdog

    jdog Senior Member
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    just want to put my 2 cents in. I love capitalism. I have the choice to choose whatever I want to go into and can be a capitalist and not see any kids on medicaid if that is what i choose. Docs are doing well with insurance companies in many aspects right now, but my gretest fear as a future doctor and more importantly as an american is the election of hillary clinton to the white house within the next 10 years. if she is elected, all this is for naught as we WILL be socialized. Just my 2 cents. I don't care if it is rude to talk about politics, because it is just flat out DANGEROUS not to. If we want to continue to make good cash flow that we damn well deserve, we need to be politically active and keep the pressure on congress to keep this thing privatized.

    To the radiologists, I am very interested to see where things go in the next decade. Mammographs pay for shiz these days and I would hate to see that happen to CT, MRI, etc becaus we need good people reading these/
     
  28. The Pill Counter

    The Pill Counter Senior Member
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    There's two sides to that coin - the buyers (HMO's, medicare) are using capitalism to their advantage as well,and it seems that they're winning - single payer isn't socialism, in many ways much more efficient. I've spoken to doctors on both sides of the border and the support staff necessary to run a practice State-side is usually two to three times greater if not more. Not saying it's the solution, but there are advantages to different systems.
     
  29. rrreagan

    rrreagan Member
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    Listen, as a Radiology resident, I want to make good money just as much as the next person, but I don't go around pretending that I'm a a capitalist like you do.

    Doctors in this country are just exploiting an artificial shortage of doctors created by organizations such as the AMA, AAMC and FSMB that seek to limit the number of residency and student positions in this country.

    Moreover, if you were really a capitalist, you would open the door to foreign doctors. Let anyone who wanted to practice medicine and let the public sort it and figure out by whom they want to be seen.

    Competition is an accepted facet of life in every other profession in this country. Why should doctors be any different?

    You are NOT a capitalist. Free-trade is the hallmark of capitalism.

    You, on the other hand, are a PROTECTIONIST because you want the government to create an artificial monopoly for you to practice in.
     
  30. rrreagan

    rrreagan Member
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    Listen, as a Radiology resident, I want to make good money just as much as the next person, but I don't go around pretending that I'm a a capitalist like you do.

    Doctors in this country are just exploiting an artificial shortage of doctors created by organizations such as the AMA, AAMC and FSMB that seek to limit the number of residency and student positions in this country.

    Moreover, if you were really a capitalist, you would open the door to foreign doctors. Let anyone who wanted to practice medicine and let the public sort it and figure out by whom they want to be seen.

    Competition is an accepted facet of life in every other profession in this country. Why should doctors be any different?

    You are NOT a capitalist. Free-trade is the hallmark of capitalism.

    You, on the other hand, are a PROTECTIONIST because you want the government to create an artificial monopoly for you to practice in.
     
  31. ambulancedriver

    ambulancedriver Senior Member
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    very interesting discussion. if anything, I have finally learned how medicaid/medicare works. lol.
     
  32. Guyberros

    Guyberros Junior Member

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    What aspects of the residency application are considered most important by residency directors for radiology? (e.g. which 3rd year rotations, what kind of grades, board scores, etc):)
     
  33. Mr.Tweed

    Mr.Tweed Senior Member
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  34. denali

    denali Senior Member
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    Interesting discussion.

    IMHO rads will always be in demand because 1) an image in a courtroom beats trying to make sense of a poorly written medical record any day, 2) it seems to me that imagery makes it easier to explain some diagnoses to pts. & 3) pts. understand and expect imagery if its available for their condition. A picture is still worth a thousand words.
     
  35. piotr13

    piotr13 Member
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    Good point.
     
  36. Dr.Wolkower

    Dr.Wolkower the same to you
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    benefits-easy on the feet,good $$$, no direct patient care most of the time

    cons-exposure to radiation,living in a cube with flurescent lights,no patient care most of the time'''



    to boring is right-in my opinion
     
  37. coldsteel

    coldsteel Member
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    I have the same attitude about radiology as the original poster, but am rethinking it. I was talking to a thoracic surgeon about career choice etc, and he suggested derm or rads. He said that, just like me, he was all about excitement, adrenaline, blood, and guts as a medical student; but he said that when you're 50, tired, and have two kids in college boring sounds pretty damn good. I've heard this from several physicians. It seems that no matter what you go into, the excitement wanes pretty fast. After a while cracking a chest becomes just that: another cracked chest just like all the 1000 other cracked chests you've done. The same is true for all fields of medicine. Everything becomes routine. If you pick something that you're really interested in at least you have 99.9%, with 0.1% "interesting case" mixed in. So the question becomes what is an interesting case to you personally? i.e. if you get off on anatomical aberrations, 40 pound sarcomas, etc. then pick surgery. If it is the patient who picked up a 3 foot parasite while vacationing in the deepest recesses of Africa, then pick ID. I won't belabor the point by giving examples for every field. The point is be prepared to do whatever is routine for whichever field you choose, but choose something that you know will occasionally give you that "Wow, I've only read about this in the books!" kind of charge.
     

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