PHysician Compensation

[PrincessFiona]

Very true - but the sacrifice is being seen as not "real" doctors by other specialists and generalists.

Well, we could argue that for a lot of professions though..I mean....pathologists don't see 'live' patients, but their on-the spot diagnoses during cancer surgery, for example can make the difference between life and death. They are also often regarded as 'non-physicians' despite their medical training. What does the psychiatris sacrifice when he/she goes into psychiatry? Many a doc would chuckle and say that they aren't 'real' doctors either....we all have heard the jokes. Should they make a huge sum of money to compensate for that?

Thus the tools of a radiologist are incredibly expensive - some of the most expensive tools in the medical world, in fact, and must be paid for.

Radiology equipment is expensive, but it doesn't explain why a radiologist would take home 350-600k It might explain why an MRI is more expensive than say..an LP..both being diagnostic tests of huge value...but where should it be written that the monetary value to the clinician who reads the MRI should be more than that of the physician who performs and reads the LP? The expense/lack of expense of the equipment itself isn't really the issue....I can understand billing more for the MRI to make up for the cost of the equipment...but not to triple the salary of one of the docs. Doing that minimizes the value of other physicians. Radiologists are not the only ones who diagnose illnesses. They aren't the only physicians who perceive the shadow, see a lesion, and imagine the man."...There are other specialties where the physician administers tests...like blood/csf/skin cultures, and stands at the microscope deciding what the diagnosis is...and imagining the patient, their symptoms and the possible courses of treatment. They may spend hours going through the newest literature to find experimental treatments for fungi in the brain. That may not be equipment that costs money...but advanced training/knowledge and the ability to come up with novel treatments also has a value.

The diagnostic radiologist is a clinician who has sacrificed one of the greatest glories of the practice of medicine and its greatest responsibility - the daily contact with the ill and their families - in order to concentrate more on the essence of our profession, the pathology of the living.

OK...Jon is going to think I'm picking on him....and I'm not....I'm enjoying the debate...but....what has the surgeon sacrificed to operate on people who are not awake? Family life, personal life, personal health? I don't think that radiologists have sacrificed the greatest glory of the practice of medicine...I think that they have often made a choice based on their personal desires....a physician wishing to have less patient contact often would choose a field like radiology..a physician who enjoys the 'adrenaline rush' might choose ER or Trauma surgery, etc, etc...

To say that one field sacrifices more than another and therefore makes them deserve to earn more than 3 times what other specialties earn is a bit out there..how do we decide what is 'fair compensation' if were were to decide that there was some sacrifice inherent in choosing the 9-5, no call lifestyle of radiology? Perhaps the reward for the 'sacrifice' of direct patient care is the 9-5, no-call lifestyle

Not everyone can be a radiologist and sit in a dark room all day with little patient, let alone, people interaction.

True...just as not every physician could stomach spending their days doing pap smears and pelvic exams (ugh) (OB) or rectal exams (proctology) (double ugh...please forgive if your spouse is interested in proctology.....), or dealing with people with schizophrenia or personality disorders (psychiatry) or removing boils and looking at gross skin things (dermatology).

Thomas is ID, and he spends the majority of his day alone doing rounds...it is not a practice-based specialty...it is hospital based. Most of his day he is consulted to the bedside of patients that tend to be in comas because they are septic, etc.....he doesn't spend his days chatting it up with patients and staff.

I'd have to say though, that for the doctors that do..FP, IM, Peds, etc....they hardly are living the glories of medicine...they deal all day with cranky patients who are ticked off because they have to wait for a long time only to be seen for a few minutes because the doc has to move on to see their quota...they deal with insurance companies, non-compliant patients, etc....They might consider the radiologists to be living the glory of medicine...doctor after their name, huge salary, no patient BS

Also...let me add, that I've never heard of a radiologist not being considered a real doctor....most doctors regard the opinion of a good diagnostic radiologist rather highly.


My point here is not to put down radiology...it is to put down the idea of medical elitism....this whole "my specialty is more important than your specialty" thing.

Back to the compensation issue....How should physician compensation be changed?

kris

[SueC]

This is an interesting debate guys and I admit things do seem a little skewed. I do think the docs that go for further training deserve more $$ (gee--I wonder why...could it be because my hubby is doing a fellowship?!) On the other hand, we've got a friend who went the derm route and he is making bank doing a 9-5 schedule with little to no call. Part of me is a tad jealous, but then again, this guy was number 2 in his graduating class and he could pretty much write his ticket. I couldn't blame him for choosing such a cushy profession. I think there do need to be some changes, but I wouldn't even begin to know where to start.

[Rapunzel]

Kris, you really should go back and read my response as to why radiologists get paid more - to sum it up I stated it is due to two factors: 1)The profession closely controls its numbers resulting in more job opportunities and thus larger control over pay issues when searching for a job (and much more competition among groups over the small pool of radiologists) and 2)The nature of the profession is one which permits a radiologist to work when other physicians cannot - at home, on vacation, etc. Thus, they can bill for services rendered while on vacation for example.

Although Jon's antidotes that he wanted me to post were interesting and primarily what you responded to, my explanation (which was largely ignored) is much more pertinant to the difference in pay between radiologists and most other specialties. If other specialties want to be paid like radiology then perhaps they should look at how radiology functions and how radiologists on the whole have carefully controlled their specialty.

Jennifer

As some of you may remember, we are currently interviewing and jobseeking in nuclear medicine. I found that $600k ad last week and choked!!!!! It seems that there is a great diversity in types of nuc. med. practices and compensation all over the place. That $600k is outrageous....and the most I have seen listed anywhere. Docs are making crazy money in Florida, I've noticed. Academic work is less lucrative than clinical work. Some places give you a lot of flexibility with hours/benefits and types of procedures---some are more rigid. Some private research places pay a heck of a lot, though.

We left surgery for a number of reasons. When Alan was doing surgery he frequently complained that he could read the xrays more proficiently than some of the radiologists......and he actually caught a few diagnostic errors during his 3 years in surgery, preventing patients from unnecessary surgery. While he enjoyed the hands-on aspects of surgery, he found the intellectual/diagnostic aspects of radiology fascinating.

Oh---and just because you are in radiology does not mean you have no patient contact. I think it depends on how the practice is set up and your particular personality. In nuclear medicine, Alan very much enjoys explaining procedures to patients and their families, as needed. He has a wonderful bedside manner and is able to explain very complicated things in a down to earth way.

Regarding the compensation-----I think it's very complex and there are no easy answers. Yes, all physicians deserve compensation based on their expertise, training, individual skills, and community standards. Can we say that one type of doctor is more valueable than another??? Yes. Clearly some work harder, longer or use more technical/intellectual resources than others. If you are working to cure cancer should you get paid more than a pediatrician who is teaching a first time mother how to breast feed?? Should you be paid per hour?? Per patient??? Per difficulty level???? Per years of training to know how to do what you are doing?? There are many factors that go into making a "good" doctor.

In an ideal world, we could see how all doctors are striving for the same goals---to cure disease, ease suffering, improve life for all human beings. In this ideal world, all doctors would be on the same team and see each other as contributing to the whole cause, rather than as adversaries. I am not sure how they would be paid in this ideal world. Any ideas???

[Rapunzel]

Oh---and just because you are in radiology does not mean you have no patient contact. I think it depends on how the practice is set up and your particular personality. In nuclear medicine, Alan very much enjoys explaining procedures to patients and their families, as needed. He has a wonderful bedside manner and is able to explain very complicated things in a down to earth way.

I asked Jon about this and he said this is a very rare thing - at least at his program. Usually you have even less patient contact in nuclear meds. Most patient contact is in interventional and mammography. He also said that explaining a nuclear med study is not regarded as an example of meaningful patient contact by other clinicians.

1)The profession closely controls its numbers resulting in more job opportunities and thus larger control over pay issues when searching for a job (and much more competition among groups over the small pool of radiologists)

Dermatology does the same thing. I can't believe how many people have said to Eric "we need more dermatologists -- I had to wait 8 weeks for an appointment." Derm programs are very slowly adding a program position here or there but I think there will be a lot of pent up demand for a long time -- which probably influences the higher reimbursement that derms get (for better or for worse).