8 ms·

I had a different experience. Medical school was easy, I was single and went out drinking / partying two or three nights a week. Not to be crass, but I did well

I had a different experience. Medical school was easy, I was single and went out drinking / partying two or three nights a week. Not to be crass, but I did well with the ladies. Luckily I can get by on four hours of sleep or less. So, I don't feel like I missed out on much of the early twenties experience. Most of my non-medical friends had jobs and I didn't, but that was the only real difference. Things got a little more serious my intern year, but I still managed to go out twice a week, and the nurses were much more responsive to my advances now that I was doctor. At the start of my residency I got serious with a girl from my medical school. Her training was in Psychiatry and I was in Radiology. We worked a minimum of 80 hours a week, but we always had time for each other. We got married during third year. Now I'm a partner in a successful practice, and she's taking a few years off to raise the kids. I make over 800k a year, and take 14 weeks of vacation. I don't deal with patients. I have the ultimate job security. And, I am a tremendous resource for my family. I'm sure you know how easy it is to get screwed by the medical system. That won't happen to me or mine. I'm not a risk taker, so what else could I be doing with the security and benefits of my current job? Lawyer, maybe.

patrickgzill 15y ago
Thank you for your honesty. May I ask, what exactly do you do that you feel justifies your 800k per year? It seems to me that your career is ripe for disruption.
- adrianwaj 15y ago
  Disruption is learning about and becoming healthy, or for example, one may spend their life savings on some supposed cancer treatment involving chemo, surgery and radiation.
- marknutter 15y ago
  He makes that much as a partner of a practice, not as a doctor at a hospital. This is no different than being a founder of a successful small business.
  - roentgen 15y ago
    Correct. When a CT scan is performed, there are two charges generated. A 'Technical Fee' for performing the study, and a 'Professional Fee' for reading it. The technical fee is almost always larger. If you work for a hospital they keep the technical fee, and you get whatever professional fees you can collect. Insurance companies hate paying, so they will find any reason to deny. Collection rates range between 60% and 80%. My partners and I own imaging centers, we collect both fees. So we are running a business, and I don't consider it small anymore.
  - billjings 15y ago
    It's also worth noting that radiology has been undergoing some significant transformations. Formerly, a practice would contract with one nearby hospital to read their cases. With the advent of teleradiology, though, it is no longer necessary for the practice to be all that close to the hospital. As a result, radiological practices are contracting with more hospitals. They are growing and sometimes putting smaller practices out of business. So I imagine there are some big winners and losers out there in the field of radiology. I don't have first hand knowledge of this; I am a programmer. I hear about this from a family member who is a radiologist. roentgen may obviously speak with more authority about his situation.
    - roentgen 15y ago
      My group does this, but not because we're evil. Larger groups often have fellowship trained radiologists who are experts in a certain sub-specialty, for example Neuroradiology. Smaller groups are usually all 'general' radiologists. If we can read pediatric brain MRIs more accurately from across the country than the local small group, why shouldn't we? One additional note. My 'customers' are not really the patients, my customers are the physicians who order the studies. Most hospitals and referring physicians demand that I be available to speak with face-to-face, so there are parts of radiology that cannot be performed remotely.
      - Bloodwine 15y ago
        What protects you from outsourcing the reading of scans to foreign countries, such as India? Obviously some medical institutions will want to keep it all local, but won't this open up a market for cheaper, foreign competition resulting in a downward pressure on compensation?
- roentgen 15y ago
  The Health Care Finance Administration ( Medicare / Medicaid ) sets reimbursements rates, and most private insurance companies follow suit. So, I don't get to charge whatever I want to read an MRI. And, I don't order the studies that I read, other doctors do that. The only thing I can control is the number of studies I read. If I work harder and read more, I make more. It just so happens that I am very fast, and I have surrounded myself with fast partners. On average we read two or three times what other radiologists read, so we make two or three times more. As far as disruption is concerned, for now the law is on my side. Of course a doctor working in India could read studies cheaper than I could. Most doctors complain about malpractice, without understanding the benefits. Trial lawyers hold me liable for my reports, and rightly so. If I miss a small treatable cancer, it can turn into a large untreatable cancer. This liability also confers a monopoly. How can a lawyer sue a doctor in India? Consequently, in order to perform a 'final read' on a radiology study in the USA, you must have trained in USA, be credentialed in the USA, and liable in the USA. This makes it very hard to undercut on price. So, I'm not sure if I deserve what I make. There aren't a lot of people that can do my job, or withstand the training. Anyway, I'm saving everything I earn, because I don't think it will last forever.
  - andrewtbham 15y ago
    are you concerned that a computer program could eventually do your job?
    - roentgen 15y ago
      I'm not sure if you're being serious or not, but I'll answer. I happen to think real AI will not happen in my lifetime, if ever. This is not an uninformed opinion, I have MS in Neuroscience, and I'm a programmer. I'm sure others reading HN will disagree. It will take nothing less than a full artificial intelligence to do what I do. If you want to read more about early attempts, there is something called "Computer Aided Detection" that is used when reading mammograms. It is awful, and I'll let you in on a secret. Most places that CAD their mammograms do it so they can charge more, not because it helps.
      - 15y ago
- sp332 15y ago
  Generally, rare goods - and skills - are valuable. So going to school for a long time to learn an unusual skill well means that your services are more valuable. Also, providing a large amount of value in a small amount of time (like accurately interpreting the results of a scan) leads to providing huge amounts of value over the course of a year. Part of the explanation is the sheer volume of individuals he can give a reasonable amount of value to.
  - roentgen 15y ago
    Exactly, you stated it much better than I could.
  - deleted 15y ago
    [deleted]
  - Hyena 15y ago
    This only applies if those rare skills aren't rare simply because the need for them is rare. Supply and demand determines prices.
    - sp332 15y ago
      Demand isn't just about how many people want it (although a little competition is good), it's also about how much each person wants it. It seems like medical diagnosis could command a high price, even if only one person needed it.
  - kenjackson 15y ago
    So going to school for a long time to learn an unusual skill well means that your services are more valuable. It's only a rare skill because of licensing/board requirements. I'm fairly certain if you told other people they could make $250k as a radiologist, they could self-teach. The same thing could be said of programming if the only people that could practice had to be certified.
    - sp332 15y ago
      I really, really don't think that's true. Most people are not able to do this, and most of those few who could don't want to put themselves through it. And then separately, how many people would trust a self-taught diagnostician?
Cushman 15y ago
Lesson learned: If you do fine without sleep, and manage to wind up in the most lucrative specialty^, medicine may just be for you! Speaking as the son of a psychiatrist who didn't marry a radiologist: you got lucky, and your wife got luckier. Good for you guys, but that's not what a student should expect from med school any more than a CS student should expect a $10mm exit. ^Barring, what, the specialized surgeries?
- roentgen 15y ago
  Many surgical specialties earn more than I do, like Urology, Neurosurgery, Orthopedics, etc.
jpdoctor 15y ago
> I make over 800k a year Does it bother you that you are profiting handsomely from sick people?
- roentgen 15y ago
  Not at all. I'm very good at my job, and I worked very hard to get where I am. Sick people should be happy that I'm reading their CT scans. If the pay wasn't good I would have chosen a different field, and somebody else would be doing my job, less well. For reference, before medical school I worked in IT, and at the age of 23 ( 15 years ago ) I was making six figures. I left that to go back to school, partly because I knew I would be financially rewarded. Again, see my response below. I don't order the studies I read, and I don't set the reimbursement rates. Additionally, it is Medicare fraud for me to read a study and not charge for it. In short, I have very little say over what I earn.
  - Game_Ender 15y ago
    Do you worry about being replaced by computer software? You said you make $800k a year, and for that amount of money you could higher 2-3 PhDs in machine learning and computer vision for each radiologist. Do that maybe 5 times over and give them 5-10 years and productivity and costs for CT scan analysis will probably go way down. After all a radiologist armed with software that prescans each CT scan looking for interesting areas could work way faster then otherwise.
    - roentgen 15y ago
      I've sort of answered this problem above. I happen to think the problem is not solvable any time soon. If you or someone you know would like to prove me wrong, I will invest in your venture.
    - stevenbedrick 15y ago
      I can assure that there are already an awful lot of PhDs in machine learning and computer vision working on the problem of automatically analyzing medical images, and there's been lots of progress over the last few years. There's a really long way to go, however- it's one of those areas where the problem is a lot harder than it seems. Working in the field has convinced me that radiologists earn every penny, and that there are good reasons for the lengthy residencies and stringent board exams.
pradocchia 15y ago
> I make over 800k a year, and take 14 weeks of vacation. I, for one, am disheartened by this gross misallocation of resources, but good work on the vacation time.
- reason 15y ago
  He's running a business; what's not to get? He sits higher up on the ladder with a bigger net than most doctors. The doctor that reads your x-ray at the local community hospital and this guy are in two different positions. One is an employee, the other is a business founder. The amount of money that you and the insurance companies pay to both are no different.
- giardini 15y ago
  The median salary for experienced radiologists is $300k-400k. And increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning). But roentgen claims to be a businessman as well as a radiologist. If so, most of his income would be from several radiology businesses. In that case the 800k/year number would not be surprising. Always remember - "On the Internet no one knows you're a dog." and - "Don't believe everything you read."
  - roentgen 15y ago
    If you read my other comments, I state that I make twice the average salary, because I read twice as many films. > increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning). This is not true. Some "preliminary reads" are read overseas at night, but the doctors reading the studies are trained and certified in the USA. "Final reads", the CT scan report that counts, cannot be read elsewhere.
    - deleted 15y ago
      [deleted]
    - 15y ago
ender7 15y ago
If you are still in radiology, I'm not surprised by this. Radiology is one of the few times that you can be a doctor and expect to work something like a 9-5 day. There are other ways to have a decently normal life as a doctor, but on average it's a pretty hard life.
- roentgen 15y ago
  True, but I knew about the lifestyle when I picked radiology, and it is a very hard residency to get. There are others with a similar lifestyle, like Dermatology, Ophthalmology, and Radiation Oncology. Guess what? They are the hardest residencies to get into when you finish medical school. I should make clear why I'm replying in this thread. The world needs good doctors, and I want bright and ambitious readers of this site to know that there is a potential upside.
  - kyro 15y ago
    I know this is off-topic, but I figured I'd take the opportunity to ask: As a medical student who aspires to enter radiology and ultimately own imaging centers, like you, what advice can you offer that'd help me and other HN-med students position ourselves to be appealing candidates for a radiology residency?
    - roentgen 15y ago
      I don't know any secrets. It's hard to get a radiology residency. You need good grades. I don't think research experience matters. It also helps to be somewhat normal. The people interviewing you for residency have to be willing to sit next to you for four years, so if you're a "closet case" they might pass on you, even if you look good on paper.
    - larrys 15y ago
      "and ultimately own imaging centers" Contact the MD here for advice: http://upper-dublin-mri.com/aboutus.aspx http://upper-dublin-mri.com/aboutus.aspx A nice guy, he was glad to help when I was thinking of starting up an imaging center. (The upshot from the meeting is that you have to have a tie in with a hospital and be aware that the hospital could end up doing the same in house etc. He's a businessman and a MD and would have profited from the association so I believe the advice was honest. Of course it's only one data point out of many you will collect.)
zmanian 15y ago
I'd describe you as a possessing several traits that make you well suited for a career in medicine. Hypomanic personality. Characterized by low need for sleep, excessive energy. High IQ/ general intelligence. Low tolerance for risk. You are probably making less money than you could as entrepreneur or in finance but that's consistent with your risk tolerance. The professional medical career path is almost ideal for you and the author of the original post would probably acknowledge this. This is probably less true for many of the individuals who are steered into medicine by the elite educational system.
- roentgen 15y ago
  You have accurately described me.
deleted 15y ago
[deleted]
steve8918 15y ago
In terms of job security, I heard that many hospitals are outsourcing radiology to India, ie. sending the X-rays, etc, over the internet and getting them diagnosed in India, by equally competent Indian doctors. Is this true, and if so, do you think this might jeopardize at least radiology in the US?

patrickgzill 15y ago

Thank you for your honesty. May I ask, what exactly do you do that you feel justifies your 800k per year? It seems to me that your career is ripe for disruption.

adrianwaj 15y ago
Disruption is learning about and becoming healthy, or for example, one may spend their life savings on some supposed cancer treatment involving chemo, surgery and radiation.
marknutter 15y ago
He makes that much as a partner of a practice, not as a doctor at a hospital. This is no different than being a founder of a successful small business.
- roentgen 15y ago
  Correct. When a CT scan is performed, there are two charges generated. A 'Technical Fee' for performing the study, and a 'Professional Fee' for reading it. The technical fee is almost always larger. If you work for a hospital they keep the technical fee, and you get whatever professional fees you can collect. Insurance companies hate paying, so they will find any reason to deny. Collection rates range between 60% and 80%. My partners and I own imaging centers, we collect both fees. So we are running a business, and I don't consider it small anymore.
- billjings 15y ago
  It's also worth noting that radiology has been undergoing some significant transformations. Formerly, a practice would contract with one nearby hospital to read their cases. With the advent of teleradiology, though, it is no longer necessary for the practice to be all that close to the hospital. As a result, radiological practices are contracting with more hospitals. They are growing and sometimes putting smaller practices out of business. So I imagine there are some big winners and losers out there in the field of radiology. I don't have first hand knowledge of this; I am a programmer. I hear about this from a family member who is a radiologist. roentgen may obviously speak with more authority about his situation.
  - roentgen 15y ago
    My group does this, but not because we're evil. Larger groups often have fellowship trained radiologists who are experts in a certain sub-specialty, for example Neuroradiology. Smaller groups are usually all 'general' radiologists. If we can read pediatric brain MRIs more accurately from across the country than the local small group, why shouldn't we? One additional note. My 'customers' are not really the patients, my customers are the physicians who order the studies. Most hospitals and referring physicians demand that I be available to speak with face-to-face, so there are parts of radiology that cannot be performed remotely.
    - Bloodwine 15y ago
      What protects you from outsourcing the reading of scans to foreign countries, such as India? Obviously some medical institutions will want to keep it all local, but won't this open up a market for cheaper, foreign competition resulting in a downward pressure on compensation?
roentgen 15y ago
The Health Care Finance Administration ( Medicare / Medicaid ) sets reimbursements rates, and most private insurance companies follow suit. So, I don't get to charge whatever I want to read an MRI. And, I don't order the studies that I read, other doctors do that. The only thing I can control is the number of studies I read. If I work harder and read more, I make more. It just so happens that I am very fast, and I have surrounded myself with fast partners. On average we read two or three times what other radiologists read, so we make two or three times more. As far as disruption is concerned, for now the law is on my side. Of course a doctor working in India could read studies cheaper than I could. Most doctors complain about malpractice, without understanding the benefits. Trial lawyers hold me liable for my reports, and rightly so. If I miss a small treatable cancer, it can turn into a large untreatable cancer. This liability also confers a monopoly. How can a lawyer sue a doctor in India? Consequently, in order to perform a 'final read' on a radiology study in the USA, you must have trained in USA, be credentialed in the USA, and liable in the USA. This makes it very hard to undercut on price. So, I'm not sure if I deserve what I make. There aren't a lot of people that can do my job, or withstand the training. Anyway, I'm saving everything I earn, because I don't think it will last forever.
- andrewtbham 15y ago
  are you concerned that a computer program could eventually do your job?
  - roentgen 15y ago
    I'm not sure if you're being serious or not, but I'll answer. I happen to think real AI will not happen in my lifetime, if ever. This is not an uninformed opinion, I have MS in Neuroscience, and I'm a programmer. I'm sure others reading HN will disagree. It will take nothing less than a full artificial intelligence to do what I do. If you want to read more about early attempts, there is something called "Computer Aided Detection" that is used when reading mammograms. It is awful, and I'll let you in on a secret. Most places that CAD their mammograms do it so they can charge more, not because it helps.
    - 15y ago
sp332 15y ago
Generally, rare goods - and skills - are valuable. So going to school for a long time to learn an unusual skill well means that your services are more valuable. Also, providing a large amount of value in a small amount of time (like accurately interpreting the results of a scan) leads to providing huge amounts of value over the course of a year. Part of the explanation is the sheer volume of individuals he can give a reasonable amount of value to.
- roentgen 15y ago
  Exactly, you stated it much better than I could.
- deleted 15y ago
  [deleted]
- Hyena 15y ago
  This only applies if those rare skills aren't rare simply because the need for them is rare. Supply and demand determines prices.
  - sp332 15y ago
    Demand isn't just about how many people want it (although a little competition is good), it's also about how much each person wants it. It seems like medical diagnosis could command a high price, even if only one person needed it.
- kenjackson 15y ago
  So going to school for a long time to learn an unusual skill well means that your services are more valuable. It's only a rare skill because of licensing/board requirements. I'm fairly certain if you told other people they could make $250k as a radiologist, they could self-teach. The same thing could be said of programming if the only people that could practice had to be certified.
  - sp332 15y ago
    I really, really don't think that's true. Most people are not able to do this, and most of those few who could don't want to put themselves through it. And then separately, how many people would trust a self-taught diagnostician?

Cushman 15y ago

Lesson learned: If you do fine without sleep, and manage to wind up in the most lucrative specialty^, medicine may just be for you! Speaking as the son of a psychiatrist who didn't marry a radiologist: you got lucky, and your wife got luckier. Good for you guys, but that's not what a student should expect from med school any more than a CS student should expect a $10mm exit. ^Barring, what, the specialized surgeries?

roentgen 15y ago
Many surgical specialties earn more than I do, like Urology, Neurosurgery, Orthopedics, etc.

jpdoctor 15y ago

> I make over 800k a year Does it bother you that you are profiting handsomely from sick people?

roentgen 15y ago
Not at all. I'm very good at my job, and I worked very hard to get where I am. Sick people should be happy that I'm reading their CT scans. If the pay wasn't good I would have chosen a different field, and somebody else would be doing my job, less well. For reference, before medical school I worked in IT, and at the age of 23 ( 15 years ago ) I was making six figures. I left that to go back to school, partly because I knew I would be financially rewarded. Again, see my response below. I don't order the studies I read, and I don't set the reimbursement rates. Additionally, it is Medicare fraud for me to read a study and not charge for it. In short, I have very little say over what I earn.
- Game_Ender 15y ago
  Do you worry about being replaced by computer software? You said you make $800k a year, and for that amount of money you could higher 2-3 PhDs in machine learning and computer vision for each radiologist. Do that maybe 5 times over and give them 5-10 years and productivity and costs for CT scan analysis will probably go way down. After all a radiologist armed with software that prescans each CT scan looking for interesting areas could work way faster then otherwise.
  - roentgen 15y ago
    I've sort of answered this problem above. I happen to think the problem is not solvable any time soon. If you or someone you know would like to prove me wrong, I will invest in your venture.
  - stevenbedrick 15y ago
    I can assure that there are already an awful lot of PhDs in machine learning and computer vision working on the problem of automatically analyzing medical images, and there's been lots of progress over the last few years. There's a really long way to go, however- it's one of those areas where the problem is a lot harder than it seems. Working in the field has convinced me that radiologists earn every penny, and that there are good reasons for the lengthy residencies and stringent board exams.

pradocchia 15y ago

> I make over 800k a year, and take 14 weeks of vacation. I, for one, am disheartened by this gross misallocation of resources, but good work on the vacation time.

reason 15y ago
He's running a business; what's not to get? He sits higher up on the ladder with a bigger net than most doctors. The doctor that reads your x-ray at the local community hospital and this guy are in two different positions. One is an employee, the other is a business founder. The amount of money that you and the insurance companies pay to both are no different.
giardini 15y ago
The median salary for experienced radiologists is $300k-400k. And increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning). But roentgen claims to be a businessman as well as a radiologist. If so, most of his income would be from several radiology businesses. In that case the 800k/year number would not be surprising. Always remember - "On the Internet no one knows you're a dog." and - "Don't believe everything you read."
- roentgen 15y ago
  If you read my other comments, I state that I make twice the average salary, because I read twice as many films. > increasingly radiology has been outsourced overseas with mostly technicians required stateside (scan during the day, radiologist in India examines at night, results available the next morning). This is not true. Some "preliminary reads" are read overseas at night, but the doctors reading the studies are trained and certified in the USA. "Final reads", the CT scan report that counts, cannot be read elsewhere.
  - deleted 15y ago
    [deleted]
  - 15y ago

ender7 15y ago

If you are still in radiology, I'm not surprised by this. Radiology is one of the few times that you can be a doctor and expect to work something like a 9-5 day. There are other ways to have a decently normal life as a doctor, but on average it's a pretty hard life.

roentgen 15y ago
True, but I knew about the lifestyle when I picked radiology, and it is a very hard residency to get. There are others with a similar lifestyle, like Dermatology, Ophthalmology, and Radiation Oncology. Guess what? They are the hardest residencies to get into when you finish medical school. I should make clear why I'm replying in this thread. The world needs good doctors, and I want bright and ambitious readers of this site to know that there is a potential upside.
- kyro 15y ago
  I know this is off-topic, but I figured I'd take the opportunity to ask: As a medical student who aspires to enter radiology and ultimately own imaging centers, like you, what advice can you offer that'd help me and other HN-med students position ourselves to be appealing candidates for a radiology residency?
  - roentgen 15y ago
    I don't know any secrets. It's hard to get a radiology residency. You need good grades. I don't think research experience matters. It also helps to be somewhat normal. The people interviewing you for residency have to be willing to sit next to you for four years, so if you're a "closet case" they might pass on you, even if you look good on paper.
  - larrys 15y ago
    "and ultimately own imaging centers" Contact the MD here for advice: http://upper-dublin-mri.com/aboutus.aspx http://upper-dublin-mri.com/aboutus.aspx A nice guy, he was glad to help when I was thinking of starting up an imaging center. (The upshot from the meeting is that you have to have a tie in with a hospital and be aware that the hospital could end up doing the same in house etc. He's a businessman and a MD and would have profited from the association so I believe the advice was honest. Of course it's only one data point out of many you will collect.)

zmanian 15y ago

I'd describe you as a possessing several traits that make you well suited for a career in medicine. Hypomanic personality. Characterized by low need for sleep, excessive energy. High IQ/ general intelligence. Low tolerance for risk. You are probably making less money than you could as entrepreneur or in finance but that's consistent with your risk tolerance. The professional medical career path is almost ideal for you and the author of the original post would probably acknowledge this. This is probably less true for many of the individuals who are steered into medicine by the elite educational system.

roentgen 15y ago
You have accurately described me.

deleted 15y ago

[deleted]

steve8918 15y ago

In terms of job security, I heard that many hospitals are outsourcing radiology to India, ie. sending the X-rays, etc, over the internet and getting them diagnosed in India, by equally competent Indian doctors. Is this true, and if so, do you think this might jeopardize at least radiology in the US?