Wednesday, December 31, 2008

Radiologist Salary Facts

There is a lot of information available about radiologist salaries. However, when assessing this information, you have to consider the quality of the information. Since there is no centralized, standard database of radiologist salary data, the majority of the information available is based on physician surveys. These surveys have several flaws that you have to bear in mind. 

First, the radiologist salary survey has selection bias, meaning not all radiologists responded. Think about it: who is going to respond to the survey, the radiologist who is busy making money, or the one who is not and has the time to respond to a survey? How often do you respond to surveys? ... exactly. If this is true, the data out there must be underestimating the true mean salary.

Also, some of the reports do not make a distinction between radiology residents and full-time radiologists. If you want to compare radiologist salary, you have to compare apples to apples. A fully-licensed radiologist can easily make 10x as much as a resident, again weighing down the numbers commonly reported. If you remove the radiology resident data, the average will necessarily be higher, reflecting figures more commonly quoted in the market. 

Lastly, you have to factor in other key variables, such as years of experience, practice location, and specialty. Obviously, as years of experience increase, so does salary, especially 5 - 10 years out, when most radiologists in private practice make partner. Practice location also plays an important role. Radiologists in urban areas command a lower salary because there is more competition for these spots. Suburban areas do the best. Rural areas can have positions with good compensation, but they typically have fewer resources as well as less demand. Radiologists are increasingly receiving fellowship training, which can significantly affect income. One survey reported an average of $100,000 difference in annual salaries between diagnostic radiologists and interventional radiologists!

Keeping all this in mind, the latest data for 2008 show an average radiologist salary of approximately $395,000 based on several different surveys. As mentioned above, radiologists with more experience, working in suburban areas, and practicing interventional radiology were paid the most. Anecdotally speaking, some radiologists in particularly lucrative private practices can make upwards of $2.4 million per year! 

Regardless of the variations in salary between radiologists, the field of a radiology as a whole compares very favorably with other specialties within medicine. In fact, radiologists often make more than many surgeons. Of course, highly specialized surgeons still command a higher salary, but salaries for general surgeons have steadily eroded over the years as they have lost ground to specialists and interventionalists. In constrast, radiologist salary continues to increase, although at a slower rate than before. Although radiology itself faces some pressures from other fields, the nature of the work makes it less likely that other fields will encroach on radiology's turf. 

If you want to learn more about the average radiologist salary as well as facts about salaries in general, consider reading the following resources:

Sunday, December 28, 2008

A Day In The Life Of A Radiologist

Radiologists are often seen as being a relatively easy specialty within medicine. This cannot be further from the truth. While certainly less demanding than other fields like surgery, radiologists remain very active during the day. Here is one radiologist's experience:

Dr. Michael arrives in his office just before 8:00 a.m. and tries to set it up for the coming onslaught. He sets his stereo to soothing classical music and turns down the overhead lights. On this day, he is able to snatch five minutes of set-up time. During this brief break, he thinks back to medical school, all the hours studying, preparing for USMLE Step 1, writing notes, being at the bottom of the totem pole.  But then the action starts. The phone rings—one of the receptionists is sending Dr. King down to the office. He wants to go over some films. Dr. Michael barely has time to look at today's schedule, which has him assigned to fluoroscopy-upper GIs and barium enemas, basically.

No sooner is he able to figure out his assignment, then one of the "fluoro" x ray technicians, Bernadette, comes into his office to cheerfully announce that the first UGI series is ready. Just then, Dr. King rolls in, so Michael tells Bernadette to hang on for a few minutes so that he can go over films with Dr. King. Fortunately, on this day, the findings on the films are found and explained quickly by Dr. Michael; while Dr. King explains the clinical circumstances and they compare notes.

Dr. Michael would love to chat with Dr. King about this, that, and another thing, but right now he has a patient and tech waiting for him in a fluoro room, so he must cut this social encounter short. These interactions with the clinical staff, a mixture of professional and nonprofessional, are a very important part of Dr. Michael's workday and important for the patient too. When a clinician and radiologist exchange medical information, the patient surely benefits. But Bernadette and the patient are still waiting.

It's just 8:15 when Dr. Michael walks into the fluoro room to do his first case. He introduces himself, induces the patient to drink barium, and takes a number of x-rays. This patient wants to know what is going on before she leaves. Dr. Michael is happy that patients are actually becoming enlightened consumers, asking questions about diabetes care, diabetes supplies, and even diabetes treatment options. He even shows the patient her esophagus on the fluoroscopy screen to which she exclaims "Gross!" That terminates the tutorial. Finished with the case, Michael goes back to his office to check if the emergency films have been read yet. In an acute care hospital, chest x-rays on certain inpatients are frequently obtained more than once a day. These patients are often very sick, and they are often awakened at first light for a daily chest x-ray; those films need to be read.

For more of Dr. Michael's story, check out the Radiology Channel (

Clearly, a radiology job is not sedentary, so you can forget those compression socks! Lower extremity edema is one thing a radiologist certainly does not have to worry about. A radiologist is active and dynamic, making important decisions throughout the day, affecting patient care in a myriad of ways. To be a good radiologist, you must be able to process large amounts of information, think on your feet, make decisions quickly yet accurately, and be able to communicate your decisions to other members of the patient care team. In many cases, the decisions made by a radiologist have far-ranging impacts on the care of a patient. Any good radiologist should always strive for excellence, given how important their role is. 

Becoming A Radiologist

Radiology, or diagnostic imaging, is a vast and diverse field. Needless to say, becoming a radiologist takes some effort, as one must master this challenging material and then become proficient at applying at to a high volume of images. Before even considering how to become a radiologist, one must focus on becoming a doctor. The general path to becoming a radiologist involve applying and being admitted to medical school, being a successful medical student, applying to residency programs, and then finally gaining the requisite experience during one's residency as well as passing the radiology specialty board exams, administered by the American Board of Radiology. Many radiology residents also go on to complete fellowship training in a subspecialty of radiology before pursuing a career. 

The task of becoming a diagnostic radiologist is not an easy one. Radiology is a competitive field. Each year, hundreds of applicants from within the United States as well as international medical graduates apply for approximately 900 residency training spots in roughly 100 programs located across the United States. While not as competitive as other residencies such as dermatology or radiation oncology, the field is definitely above average within the medical specialties. Even after a resident matches, they face another 5 to 6 years of intense training as well as two major exams before even their first day practicing as a diagnostic radiologist. If you are determined to become a radiologist, you must be willing to make this kind of commitment. 

To learn more, check out How To Become A Radiologist. Other good resources include Aunt Minnie (a website and forum dedicated to radiology) as well as the Wikipedia article on Radiology. 

Saturday, December 27, 2008

What Is A CT / CAT Scan (Computed Tomography)?

A CT or "Cat" scan has become a common term as the use of this modality has skyrocketed. Either through personal use or depictions on shows like "ER", the public has come to accept the technology without really understanding what it is. According to Wikipedia:

"Computed tomography (CT) is a medical imaging method employing tomography. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. The word "tomography" is derived from the Greek tomos (slice) and graphein (to write).

Computed tomography was originally known as the "EMI scan" as it was developed at a research branch of EMI, a company best known today for its music and recording business. It was later known as computed axial tomography (CAT or CT scan) and body section röntgenography.

CT produces a volume of data which can be manipulated, through a process known as windowing, in order to demonstrate various structures based on their ability to block the X-ray/Röntgen beam. Although historically (see below) the images generated were in the axial or transverse plane (orthogonal to the long axis of the body), modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures.

In the early 1900s, the Italian radiologist Alessandro Vallebona proposed a method to represent a single slice of the body on the radiographic film. This method was known as tomography. The idea is based on simple principles of projective geometry: moving synchronously and in opposite directions the X-ray tube and the film, which are connected together by a rod whose pivot point is the focus; the image created by the points on the focal plane appears sharper, while the images of the other points annihilate as noise. This is only marginally effective, as blurring occurs only in the "x" plane. There are also more complex devices which can move in more than one plane and perform more effective blurring.

Tomography had been one of the pillars of radiologic diagnostics until the late 1970s, when the availability of minicomputers and of the transverse axial scanning method, this last due to the work of Godfrey Hounsfield and South African born Allan McLeod Cormack, gradually supplanted it as the modality of CT.

The first commercially viable CT scanner was invented by Sir Godfrey Hounsfield in Hayes, United Kingdom at EMI Central Research Laboratories using X-rays. Hounsfield conceived his idea in 1967, and it was publicly announced in 1972. Allan McLeod Cormack of Tufts University in Massachusetts independently invented a similar process, and both Hounsfield and Cormack shared the 1979 Nobel Prize in Medicine."

While this description is accurate, I'd like to put it in even simpler terms. A CT scan is simply a series of plain x-ray films that have been taken at precise intervals so that a computer can reconstruct an image of a 'slice' through that body. The computer uses geometry and other calculations to perform this feat. As an analogy, imagine you have a watermelon. A "w-ray" lets you see the shadow of the seeds inside the watermelon if you point the w-ray at it. If you shot one w-ray, you'd simply see a line on the other side, because the seed shadows would be compressed. However, if you shot another w-ray at an angle to the first, the shadows would shift but by differing amounts. Using geometry, you could use these shifts to triangulate the location of the seeds within the watermelon. If you shot enough w-rays, you would get a very precise picture of where exactly the seeds are located within the watermelon, the same as you would get if you had "sliced" the watermelon and looked at a flat section of it. This is the basic idea behind CT.

As CT scans have become more prevalent, the cost has fallen. However, they are still far more expensive and resource intensive than plain x-ray images. As CT scan have become more widely accepted by the medical community and requested by patients, insurance plans including Medigap insurance, have broadened the CT studies for which they would provide reimbursement. In most cases, especially in trauma situations, insurance providers will cover the majority of the cost of CT exams.

Recent innovations have helped expand the uses of CT into areas such as cardiac imaging. The original CT had a tough time imaging moving objects, such as the heart. However, new CT machines use multiple sources of radiation to speed up the acquisition time, allowing more precise imaging of moving structures. Such advances have helped the modality revolutionize the world of diagnostic imaging.

Wednesday, December 24, 2008

What Is A Radiologist?

A diagnostic radiologist is a doctor (licensed M.D.) who uses images acquired through various modalities to help make medical decisions. Radiologists require a lot of training. To become a radiologist in the United States, one must complete secondary education, an undergraduate degree, four years of medical school, an internship, and residency training. Many radiologists also receive training within a subspecialty of radiology through a one year fellowship after the diagnostic radiology residency. Major subspecialties in radiology include neuroradiology, mammography, body CT, musculoskeletal imaging, and interventional radiology. Along with the training, radiologists must pass several board exams from the American Board of Radiology (ABR) during their residency training. 

Once fully certified, a diagnostic radiologist can work in a variety of medical settings. The two major practice settings are academic radiology and private practice radiology. Private practices usually involve several radiologists who either run an independent diagnostic imaging center or contract with a hospital to provide their services.

Academic radiologists are associated with medical schools and their teaching hospitals. They are more involved in training radiologists and performing academic research. Academic radiologists typically receive lower pay, but work fewer hours. The diagnostic radiologists within academia report being more satisfied with their job as well, relative to their private practice peers, in surveys of practicing radiologists. 

Most physicians trained as diagnostic radiologists interpret films. The radiologist then makes an interpretation of the film and provides their assessment to the physician who ordered the film. The assessment can involve making the diagnosis, discussing treatment options, or judging how effective a treatment has been. Interventional radiologists train as diagnostic radiologists during residency, but after their fellowship, they perform procedures primarily. Contrary to stereotypes, radiologists often interact with many physicians, providing much appreciated advice on how to proceed with patient care. Radiologists are also often at the front lines of screening initiatives, such as encouraging women to get mammograms. 

Related fields to diagnostic radiology are radiation oncology and radiology technology. However, radiation oncologists receive separate residency training and are more heavily involved in patient care. Radiology technologists or x ray technicians assist diagnostic radiologists in acquiring images. They receive their training in separate radiology technology schools, where upon completion, they typically receive an associate's degree. 

Tuesday, December 23, 2008

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About This Blog

Radiology is a dynamic, growing field that plays a critical role in healthcare today. Radiology is patient-centered, helping physicians of all specialties diagnose, manage, and treat their patients. Within radiology, there are many subspecialties, with new technology aimed at making radiology more accessible and more affordable. 

This blog was created to post information on radiology education, radiology training, and radiology jobs. New developments and current events will also be covered. For more information, contact us at The Radiology Blog