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Comment by marknutter | Hacker News Reader

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.

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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.

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.

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?

Trust. FMG (foreign medical graduates) have an extremely low reputation in the US. It's a component of defensive medicine.

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.

Do you think this Medicare law is useful for protecting consumers?

Not really, no.

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.

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