Thursday, January 29, 2009

Radiologist Salary Trends

The trend of radiologist salaries is, needless to say, one of great import to those within the field of radiology, whether they like to admit it or not. I was recently talking to a friend of mine, who is an excellent student, and will no doubt make a great pediatrician some day. Fortunately for them, pediatrics is not too competitive, so they had their choice of programs. After complimenting them on how easy life must be, they retorted, "Well, don't worry, you'll be fine, and you'll end up making three times as much as me!" They said it jokingly, but it was the first time someone had ever associated me directly with the earning potential of a radiologist and compared it to their chosen specialty.

Radiology Salary Trends: Will It Last?

As I replied to my friend, I noted that radiology often faces encroachment from other specialties, such as cardiology, gastroenterology, and neurosurgery, as these referrers bring their own patients. At any time, they (as a group) could decide to not refer to a radiologist and start reading their own films. While it's not truly as simple as that, you can see that some areas, they have succeeded, such as wresting interventional cardiology away from the radiologists and into the hands of the cardiologists. My friend was not buying it: you're still going to make more than me, they retorted, but perhaps not as high a multiple! 

Are Radiologist Salaries Too High?

Some influential radiologists have considered whether we in fact are getting paid too much. In one opinion piece, the radiologist Howard P. Forman of Yale Radiology notes:

"Unlike other specialists and primary care providers, we perform a service that is requested. Simple supply and demand economics would dictate a higher salary for radiologists since the number of radiologists in practice has not kept pace with the increased demand for our services. In 2001, 4,176 diagnostic and 274 therapeutic radiology procedures were performed per 1,000 Medicare non–managed care enrollees [3]. The study, which appeared inRadiology in 2005 found that "on average, between 1998 and 2001, utilization per Medicare enrollee increased 16% per year for MRI and 7%–15% per year for CT, ultrasound, interventional radiology, and nuclear medicine, while that for radiography increased 1% per year." [3] At the same time, the number of those certified by the American Board of Radiology remains somewhat steady. In 1999, the American Board of Radiology issued 1,218 new general certificates; in 2002, 1,114 certificates were issued and in 2005, 1,335 new certificates were issued [4].

Our salaries are assumedly set by the market with fees negotiated with and set by commercial and government payers. However, the assumption that our fees are market-based rests on the premise of open competition. Open competition requires relatively low barriers to entry, among other things. In fact, our market is not quite so "open," and one could argue that the supply of radiologists is held back by nonmarket forces, including the Medicare and Accreditation Council on Graduate Medical Education (ACGME) limits on training positions offered.

The disproportionate number of medical students eager to enter our profession compared with the number of training positions available would, indeed, suggest that salaries are higher than a competitive market would offer. Do we benefit from this? Assuredly! We are attracting the brightest and most ambitious of our graduating medical students in this country. Ultimately, this comes at the expense of other equally important medical fields. Put a differentway, the relative attractiveness of radiology as a profession must be due, in part, to the salaries that we are paid. If radiology, in and of itself, is a very fulfilling specialty, then the salaries would be expected to be lower than average. If, on the other hand, the field had serious lifestyle obstacles, the salary might reasonably be expected to be higher than average. If the latter is the case, then one would not expect such a huge excess of medical student interest relative to training positions."


The Radiologist Salary Rebuttal

Dr. Forman goes on to note that radiologist do work hard for their income, but where does one find that balance between radiologist salaries and the other costs in the system. On the one hand, the radiologist is often highly trained, being able to spot not only a variety of natural disease processes, but also the reactions to external factors, such as chemotherapy drugs or gout treatments, or even new agents such as vivimind (an anti-Alzheimer's drug).  On the other hand though, the marginal cost of a read once a radiologist is fully trained is very low, so it is hard to justify a high salary when the only tangible outlay on the part of the radiologist is their time. Given how many other costs are facing the system, it is hard to defend this rate, even if it is nominally pegged to images read instead of time directly. 

Regardless, the debate shall continue, but I do not envy the policymaker who has to make the decisions about reimbursement rates!