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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 disrupti

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?
      - 2mur 15y ago
        Trust. FMG (foreign medical graduates) have an extremely low reputation in the US. It's a component of defensive medicine.
      - roentgen 15y ago
        See my other answers. "Final reads" must be performed my a physician who did a radiology residency in the USA, and credentialed in the USA. Note, you don't need to be located in the USA, but it doesn't matter, there is no competing on price. See my other answers. For each scan or xray performed, two fees are billed. The reimbursements are generally set in stone, and non-negotiable. Additionally, "fee-splitting" is Medicaire fraud. Meaning, if you as an independent businessperson own an imaging center and I read cases for you, you cannot keep any of my "professional fee" for reading the case. So there is no way for another radiologist to compete on price with me, it is simply illegal to offer to read the cases for less.
        15y ago
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?

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?
    - 2mur 15y ago
      Trust. FMG (foreign medical graduates) have an extremely low reputation in the US. It's a component of defensive medicine.
    - roentgen 15y ago
      See my other answers. "Final reads" must be performed my a physician who did a radiology residency in the USA, and credentialed in the USA. Note, you don't need to be located in the USA, but it doesn't matter, there is no competing on price. See my other answers. For each scan or xray performed, two fees are billed. The reimbursements are generally set in stone, and non-negotiable. Additionally, "fee-splitting" is Medicaire fraud. Meaning, if you as an independent businessperson own an imaging center and I read cases for you, you cannot keep any of my "professional fee" for reading the case. So there is no way for another radiologist to compete on price with me, it is simply illegal to offer to read the cases for less.
      - 15y ago

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?