> 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.
I, for one, am disheartened by this gross misallocation of resources, but good work on the vacation time.
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."
> 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.
Why not?
Final interpretations must be performed by a radiologist residency trained in the USA, licensed in the state there are reading from, and credentialed for the facility and the insurance company.
Why? Well, I guess it's supposed to be to ensure quality. In general, it is probably good that every hospital in the USA has an independent credentialing process. You could debate the fact that doctors in the USA are better trained, but in fact that has overwhelmingly been my experience.
Cynically, I believe that the lawyers need someone to sue. Like I said, most doctors complain about malpractice, but not me. The trial lawyers can't sue doctors overseas, but they can sue me. So, in a sense they are my ally, they ensure that no one else ( except people they can sue ) can read the studies.
That being said, there are companies that take USA trained radiologists and station them overseas. Australia and Geneva are both popular. They take advantage of the time difference to read hospital cases that occur overnight, when I am home in bed. They usually provide a preliminary read, something like "no appendicitis." The next day I do a final read, look for mistakes in the preliminary read, and in general do a more thorough job. Sure, there's no appendicitis, but the preliminary read didn't mention the small tumor in your left kidney that kind of looks like a cyst, but isn't.
FYI - overseas reads by USA trained radiologists tend to be more expensive, not less.
Anyway, thanks for jquery.
http://www1.salary.com/Physician-Cardiology-Non-Invasive-Sal...
http://www1.salary.com/neurologist-Salary.html
That radiologists make 100K more than cardiologists and 200k (!!!) more than neurologists absolutely screams market manipulation. Radiology seems literally one generation of Intel processors away from being automated into oblivion. God speed that it is.
See my response below, and look into "CAD" and mammography.
With rising costs and increasing pressure to save money in healthcare, you better believe that one day a computer will do your job.
PS You might want to re-read The Innovator's Dilemma and The Innovator's Solution.
Computers reliably interpreting films as the final word is not going to happen in the near future (within this guy's career). Reading films is as much an art as it is a science. I'm sure a lot of advances can be made on it, and we might see nice proofs of concept. But to the point that it actually replaces radiologists?
Even if you assume the technology can be perfected, there are too many non-technological hurdles for that to happen. Liability, trust, etc...
Machine EKG interpretation has been around for a while, but it's not even close to perfect and no one relies on it, and it's a much much much simpler problem.
For contrast, look at http://www.lifeclinic.com/fullpage.aspx?prid=508121&type... There they decided to stop gathering lots of information and making a judgement and instead use a few simple rules to make a decision on whether someone was having a heart attack and how bad. It was more accurate.
I have been programming computers since I was 5 years old. I have a MS in neuroscience, and I am a board certified radiologist, so I think I'm qualified to understand the problem.
Believe it or not, nothing would make me happier than a magical black box that could spit out accurate radiology reports. Someday I'm going to get sick, and I would benefit from the technology.
If my job was replaced tomorrow I would be OK. I'm smart and hard working, and I'm good at almost everything I try, eventually. Also, I'm saving every last penny I earn, so I can keep things up for a few more years I should be financially secure.
Having said all that, I still think the problem is not solvable. On any given day I read xrays, CT scans, MRIs, ultrasounds, PET scans, mammograms, nuclear medicine studies, or live flouroscopic studies, and using CT or ultrasound guidance I can get a needle into just about any part of your body to take a biopsy. Doctors talk to me and our discussion influences the differential diagnosis, and the interventions planned. I am not just matching patterns, I am thinking and using my hard worn judgement.
Wishful thinking aside, computers cannot do this now, if ever. And if / when we reach the point that computers can do this, my guess is every other job will have fallen, with the exception of plumbing.
But never underestimate the ability of programmers to oversimplify every other job while proclaiming a computer can do it.
Computers are tools to aid doctors, they are not doctors. It's like a blacksmiths claiming the horseshoes can get you somewhere without a horse. It's just not going to happen.
Second, there must some set of scans that are easy. It's not hard to imagine a device that says, "yes" or "see a real radiologist". Perhaps later revisions can even say "No". an example might be a mammogram analyzer. I think even 10% getting an immediate answer would save a lot of money.
I think it's the normal progression of technology. Generally, you don't need a Phd in math or physics to program computers like was required in the 60's. The net effect will be the average case you look at is much more challenging.
These exist, google for "mammogram computer aided detection". While the data on their efficacy is equivocal at best, I well tell you that they are useless. I do get to bill more for reading a mammogram if I run it through a CAD machine, which my group owns, so of course I do it.
Strangely enough, patients are reassured when the learn that the computer didn't detect any problems. And, more importantly, ignorant juries can be swayed by this piece of information. "The computer didn't detect anything? Then there is no way the radiologist should be held liable for missing that little tumor!" I'm not joking.
Little do they know.
Mostly a neurologist diagnoses stuff and manages chronic disease, and how do you measure that? Arguably, the neurologist does the most difficult and complicated job. They get paid based on consultations per time, which is clearly a pretty hopeless measure.
Also, the notion that radiology is going to be automated by increased processor power is a bit ridiculous.
We are talking about a task where lives are at stake, communication and DISCUSSION with real people is required frequently, and there are large variations in the quality and modality of scanning.
Also, any data driven approach is very limited... what happens when a new MRI sequence is developed? We have to wait 15 years for real radiologists to do enough reporting so we can get a proper dataset?
Trust me, a good radiologist is easily worth that much and more. They make hundreds to thousands of decisions a day and produce data which is scrutinized carefully. Many radiology mistakes also eventually come to light through time or autopsy, so they are also accountable.
People in other jobs are paid more to do far less and be far less accountable, the finance industry being the number one example. (Thanks for your good work lately.)
One final point is that medical training in other countries isn't like this. In Australia, we don't work ridiculous hours most of the time and remuneration is reasonable. As well as making actual healthcare inefficient and needlessly expensive, the US has managed to do the same to medical training.